Eight non-randomised retrospective case-control studies (1,065 cases) were included in the analysis. Patients were considered representative of the target population, their characteristics were found comparable within the study groups (where reported) and five studies had more than 90 patients followed-up for five years.
The number of complications was significantly lower following laparoscopy-assisted distal gastrectomy compared to open distal gastrectomy at 30 days (OR 0.61, 95% CI 0.42 to 0.88; eight studies). No significant differences were observed in mortality rates at 30 days and recurrence rates between the two interventions. There was no significant heterogeneity (Χ²=0%) for these outcomes.
Operative time was significantly longer for laparoscopy-assisted surgery compared to open gastrectomy, with an overall difference of approximately 37 minutes (WMD 36.51, 95% CI 15.55 to 57.46; six studies). Intraoperative blood loss was significantly lower for the laparoscopic surgery group compared to open surgery (WMD -114.73 mL, 95% CI -160.46 to -69.01; seven studies). There was evidence of very high heterogeneity for these outcomes (Χ²>90%)
First flatus and first oral intake following surgery took place significantly earlier for the laparoscopic surgery group (first flatus WMD -1.01 day, 95% CI -1.44 to -0.57; five studies, Χ²=86% and first oral intake WMD -0.95 day, 95% CI -1.19 to -0.71; three studies, Χ²=0%). Patients who received open surgery stayed in hospital for about three more days than those who received laparoscopic surgery, which was statistically significant (WMD -3.28 days, 95% CI -4.16 to -2.39; six studies, Χ²=57.4%). There were no significant differences in the number of harvested lymph nodes between the two groups.