Meta-analysis of laparoscopic versus open D2 gastrectomy in managing locally advanced gastric cancer: early postoperative course and pathological outcomes

Background
With a fifth incidence and a third death rate among all malignancies, stomach cancer is a serious worldwide health problem. The best course of treatment is removing all lymph nodes together with the tumor, increasing the likelihood of survival. Laparoscopic gastrectomy has become more common because of its advantages in terms of appearance, decreased discomfort, and shorter hospital stays; this is especially true in Korea and Japan. For locally advanced gastric cancer, it is still unclear if laparoscopic D2 gastrectomy is more feasible and effective than open surgery.
Patients and methods
This study conducted a systematic review and meta-analysis to evaluate the differences between laparoscopic and open D2 gastrectomy in terms of feasibility, radicality, surgical outcomes, and postoperative complications. PRISMA statement guidelines and Cochrane handbook for Systematic Reviews of Interventions were followed. Relevant databases were searched, and studies published between 2017 and September 2022 were included. Key outcome measures included operative time, blood loss, postoperative recovery, pathological outcomes, and lymph node involvement.
Results
The meta-analysis included a total of 22 studies. The operative time was significantly shorter for laparoscopic D2 gastrectomy compared with open surgery. However, laparoscopic D2 gastrectomy was associated with higher blood loss. Postoperative recovery measures, such as the time to first flatus and first oral intake, were significantly shorter for laparoscopic D2 gastrectomy. Pathological outcomes showed no significant differences in terms of resection margins and tumor size. The number of harvested lymph nodes did not significantly differ between laparoscopic and open D2 gastrectomy. Laparoscopic D2 gastrectomy demonstrated a lower rate of positive lymph nodes compared with open surgery.
Conclusion
Based on the findings of this meta-analysis, laparoscopic D2 gastrectomy seems to be a safe and practical procedure for treating patients with locally advanced gastric cancer. It is associated with reduced blood loss, faster postoperative recovery, equivalent postoperative complications, and comparable oncological safety. These results support the use of laparoscopic D2 gastrectomy as an effective alternative to open surgery in the management of advanced gastric cancer.