Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies

BACKGROUND: In some meta-analyses of randomized controlled trials (RCTs), laparoscopic or laparoscopy-assisted distal gastrectomy (LDG) had several short-term advantages. However, several specific postoperative complications (PCs) were not analyzed sufficiently. METHODS: RCTs and case-controlled studies (CCSs) comparing postoperative complications between LDG and open distal gastrectomy (ODG) were identified in PubMed and Embase. Studies in which patients' status, extent of lymph-node dissection, or reconstruction procedures were matched between the groups were included in a meta-analysis. Postoperative complications such as surgical-site infection (SSI; which included wound infection and intra-abdominal abscess), leakage, anastomotic stenosis, bleeding, ileus, delayed gastric emptying, pneumonia were evaluated in a meta-analysis performed using Review Manager version 5.2 software. RESULT: This meta-analysis included a total of 2144 patients (1065 underwent LDG and 1079 underwent ODG) from 5 RCTs and 13 CCSs. SSI and wound infections were reported in 14 studies, and the incidences were significantly lower in LDG than in ODG (n = 1737; odds ratio [OR] 0.50, 95% confidence interval [CI] 0.29-0.85, P = 0.01, I(2) = 0%, and OR 0.46, 95% CI 0.24-0.88, P = 0.02; I(2) = 0%). There were no significant differences in intra-abdominal abscess or other specific complications between the procedures. CONCLUSION: LDG was associated with a lower incidence of SSI, especially wound infection, as compared with ODG in a meta-analysis of both RCTs and CCSs.