Oncologic and perioperative outcomes of laparoscopic versus open gastrectomy for T4a gastric cancer: A systematic review and meta-analysis.
Maria Fernanda Queiroz Ferreira, Marcílio de Oliveira Filho, Bruno José de Queiroz Sarmento et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared laparoscopic with open gastrectomy for T4a gastric cancer, including evidence from 13 studies: 2 randomised trials and 11 non-randomised cohorts. Overall, five-year survival outcomes did not differ significantly: overall survival HR 0.95 (95% CI 0.85-1.07) and disease-free survival HR 0.91 (95% CI 0.79-1.04). Laparoscopic surgery was associated with faster postoperative recovery but longer operating time and more pancreatic fistula. Recurrence outcomes were broadly similar, although gastrectomy-type interactions were reported for overall survival and locoregional recurrence.
Key findings
- Five-year overall survival was similar between approaches (HR 0.95, 95% CI 0.85-1.07), as was disease-free survival (HR 0.91, 95% CI 0.79-1.04).
- Total, peritoneal, and hematogenous/liver recurrence did not differ; gastrectomy-type interactions were observed for five-year overall survival (P = 0.0041) and locoregional recurrence (P < 0.0001).
- Laparoscopic gastrectomy was associated with less blood loss, earlier flatus and oral intake, shorter hospital stay, and longer operative time.
- Pancreatic fistula was more frequent after laparoscopic gastrectomy (OR 2.19, 95% CI 1.05-4.58); other major safety outcomes did not differ significantly.
Why it matters
For selected patients with T4a gastric cancer, the pooled evidence suggests laparoscopic gastrectomy may offer recovery advantages without a significant overall difference in long-term survival or several recurrence outcomes. The higher pancreatic fistula rate and subgroup interactions are relevant when weighing approaches, while the mixed evidence base calls for careful interpretation.
What to keep in mind
Evidence was predominantly observational, with 11 non-randomised cohorts among 13 studies. Subgroup estimates were imprecise, limiting interpretation of the gastrectomy-type interactions.