Laparoscopic gastrectomy versus open gastrectomy for elderly patients with gastric cancer: a systematic review and meta-analysis.

BACKGROUND: The objective of this study was to evaluate the feasibility, safety, and potential benefits of laparoscopic gastrectomy (LG) comparing with open gastrectomy (OG) in elderly population. METHODS: Studies comparing LG with OG for elderly population with gastric cancer, published between January 1994 and July 2015, were identified in the PubMed, Embase, and ISI Web of Science databases. Operative outcomes (intraoperative blood loss, operative time, and the number of lymph nodes harvested) and postoperative outcomes (time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity) were included and analyzed. The Newcastle-Ottawa Scale was used to assess the quality of the pooled study. A funnel plot was used to evaluate the publication bias. RESULTS: Seven studies totaling 845 patients were included in the meta-analysis. LG in comparison to OG showed less intraoperative blood loss (weighted mean difference (WMD) -127.47; 95% confidence interval (CI) -202.79 to -52.16; P < 0.01), earlier time to first ambulation (WMD -2.07; 95% CI -2.84 to -1.30; P < 0.01), first flatus (WMD -1.04; 95% CI -1.45 to -0.63; P < 0.01), and oral intake (WMD -0.94; 95% CI -1.11 to -0.77; P < 0.01), postoperative hospital stay (WMD -5.26; 95% CI -7.58 to -2.93; P < 0.01), lower overall postoperative complication rate (odd ratio (OR) 0.39; 95% CI 0.28 to 0.55; P < 0.01), less surgical complications (OR 0.47; 95% CI 0.32 to 0.69; P < 0.01), medical complication (OR 0.35; 95% CI 0.22 to 0.56; P < 0.01), incisional complication (OR 0.40; 95% CI 0.19 to 0.85; P = 0.02), and pulmonary infection (OR 0.49; 95% CI 0.26 to 0.93; P = 0.03). No significant differences were observed between LG and OG for the number of harvested lymph nodes. However, LG had longer operative times (WMD 15.73; 95% CI 6.23 to 25.23; P < 0.01). CONCLUSIONS: LG is a feasible and safe approach for elderly patients with gastric cancer. Compared with OG, LG has less blood loss, faster postoperative recovery, and reduced postoperative morbidity.

A new technique of mesh-reinforced pancreaticogastrostomy: report of 13 initial cases.

BACKGROUND: Pancreatic anastomotic leakage is a common problem after pancreaticoduodenectomy and is a leading cause of postoperative morbidity and mortality. It is important to establish a safe and simple technique of pancreatic-enteric anastomosis to minimize pancreatic leakage. PATIENTS AND METHODS: From July 2009 to February 2012, a new method of mesh-reinforced pancreaticogastrostomy was performed in 13 patients after completion of the pancreaticoduodenal resection. Patient demographic data, pathology of lesions, operative parameters, and postoperative outcomes were analyzed. RESULTS: The mean operative time was 6.9 hours (range, 5-11 hours), and the mean time for pancreaticogastrostomy was 25 minutes (range, 22-35 minutes). Intraoperative tests showed all pancreatic anastomoses were watertight. There was no postoperative death. No patient developed clinically significant pancreatic leakage (grade B or C) after operation; 1 patient (7.7%) was recognized to have a grade A pancreatic leakage. No significant complication (hemorrhage, intra-abdominal abscess, or cholangitis) was observed. The mean postoperative hospital stay was 20 days (range, 11-30 days). After discharge, all patients recovered well in the 4-week follow-up period without emergency room visit or re-admission. CONCLUSIONS: The mesh-reinforced pancreaticogastrostomy provides a new way to perform pancreatic-enteric drainage after pancreaticoduodenectomy and has the advantages of simplicity, ease of handling, and applicability to all types of pancreatic remnants.