Totally laparoscopic total gastrectomy with linear anastomosis versus laparoscopic-assisted total gastrectomy in gastric cancer：a single-center experience with meta-analysis

Abstract Objective Laparoscopic-assisted total gastrectomy (LATG) is the most common methods of gastrectomy for gastric cancer (GC). However, totally laparoscopic total gastrectomy (TLTG) is uncommon because reconstruction is difficult, especially for the intracorporeal esophagojejunostomy. In this study, we compared short-term oncologic outcomes in TLTG group with linear anastomosis and LATG group. Methods The retrospective cross-sectional study was conducted. The clinic-pathological data of 108 patients underwent TLTG and 153 patients underwent LATG who were admitted to the First Affiliated Hospital of Nanjing Medical University between May 2016 and October 2019 were collected. The clinicopathological characteristics and surgical outcomes before and after propensity score matching (PSM) were compared between the two groups. Furthermore, a systematic review and meta-analysis were conducted. Results Besides the estimated blood loss(P < 0.001) and the length of incision(P < 0.001) in TLTG group was less than those in LATG group, no other differences were found between the two groups in operative time (P = 0.993), the number of harvested lymph nodes (P = 0.181), the time of first flatus(P = 0.076), start of liquid diet (P = 0.240), start of soft diet (P = 0.147), the time of removing drainage (P = 0.725), postoperative hospital stay (P = 0.688)and postoperative morbidity (P = 1.000) after PSM. The meta-analysis also demonstrated no significant differences in above surgical outcomes among the groups, although the number of harvested lymph nodes was higher and estimated blood loss was lower in the TLTG group than that in the LATG group. Conclusions TLTG for GC is feasible and safe. However, the further validation of high-quality randomized controlled trial is still needed.