Short-term Outcomes of Totally Laparoscopic Versus Laparoscopy-assisted Total Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis

Abstract Background Totally laparoscopic total gastrectomy (TLTG) has not been generalized because of its technical difficulty during the procedure of digestive tract reconstruction and lack of short-term results. This meta-analysis aimed to evaluate the feasibility and safety of TLTG for gastric cancer.Methods A systematic literature search in various databases from January 1994 to November 2020 was performed. Eligible studies in comparing TLTG and laparoscopy-assisted total gastrectomy (LATG) for gastric cancer were included in this meta-analysis. The results were analyzed according to predefined criteria.Results In the present meta-analysis, the outcomes of 8 non-randomized controlled studies enrolling 1503 patients (819 in the TLTG group and 684 in the LATG group) were pooled. The operation time was significantly shorter in the TLTG group than those in the LATG group (P < 0.01). Estimated blood loss was significantly less in TLTG than that in LATG (P = 0.01). The TLTG group was associated with earlier time to first flatus (P < 0.01) and oral intake (P =0.02). The pooled analysis showed no significant difference in postoperative hospital stay, postoperative complications, number of retrieved lymph nodes, and the proximal margin between TLTG and LATG groups (all P ˃ 0.05).Conclusions TLTG can be a safe and feasible procedure concerning short-term surgical outcomes and complications.