Sixteen studies (n=1,611) were included in the review: 4 RCTs and 12 non-randomised retrospective studies. All but one of the included studies was conducted in either Japan or Korea; most were published in 2005 or 2006.
The results presented are for RCTs only, unless otherwise stated.
Compared with LADG, CODG was associated with statistically significantly shorter operating times (WMD 83.1 minutes, 95% CI: 40.5, 125.6, p<0.001; there was evidence of statistical heterogeneity) and a statistically significantly greater number of dissected lymph nodes (WMD -4.34, 95% CI: -6.66, -2.02,
p<0.001; there was no evidence of statistical heterogeneity). LADG was also associated with significantly less blood loss than CODG (WMD -104.3, 95% CI: -189.0, -19.5, p=0.02; there was evidence of statistical heterogeneity).
Morbidity and mortality.
Compared with CODG, LADG was associated with statistically significantly fewer overall complications (OR 0.41, 95% CI: 0.20, 0.85, p=0.02). The likelihood of post-operative ileus was significantly lower after LADG than CODG (OR 0.27, 95% CI: 0.09, 0.84, p=0.92 for 6 studies; OR 0.31, 95% CI: 0.01, 7.91 for 1 RCT only). No statistically significant differences were reported between LADG and CODG in anastomotic stenosis (5 studies including 2 RCTs), anastomotic leakage (7 studies including 2
RCTs), wound infection (9 studies including 2 RCTs) or mortality (2 retrospective non-randomised studies).
Post-operative clinical course.
Compared with CODG, LADG was associated with a significantly shorter bowel function recovery period, as measured by the number of days to first flatus (WMD -0.68 days, 95% CI: -1.26, -0.09, p=0.02; based on 3 RCTs; there was evidence of statistical heterogeneity), and required less post-operative analgesics (WMD -1.69, 95% CI: -2.18, -1.21, p<0.001; based on 3 RCTs). No statistically significant difference was shown in the length of hospital stay (WMD -3.32 days, 95% CI: -7.69, 1.05, p=0.14; there was evidence of statistical heterogeneity); however, the results of all 15 studies showed that LADG was associated with shorter length of stay than CODG. LADG was also associated with significantly fewer numbers of days with a body temperature greater than 37 degrees C (WMD -1.25, 95% CI: -1.69, -0.82, p<0.001; based on 5 retrospective non-randomised studies). White blood cell counts and C-reactive protein levels were significantly lower in patients given LADG than in patients given CODG on post-operative days 1 and 3, but there were no significant differences between the two groups on day 7 (refer to publication for results).