Comparison of Safety and Efficacy of Open, Laparoscopic-Assisted, Totally Laparoscopic, and Robotic Gastrectomy for Gastric Cancer:A Network Meta-Analysis [post]

2019 unpublished
Several techniques are used for surgical treatment of gastric cancer (GC), but the efficacy and safety of these approaches have not been compared. Methods: We systematically searched articles of randomized controlled trials (RCTs) through PubMed, Embase, Cochrane Library and ISI-Web of Science databases. The primary outcome was safety using overall morbidity as the main indicator of safety. The secondary outcome was efficacy using the number of harvested lymph nodes (HLNs) as an indicator of
more » ... an indicator of efficacy. Multiple surgical treatment comparisons based on Bayesian network integrated the safety and efficacy of all included approaches. The ranking probability was appraised by the probability of the surgical approaches. Results: The 19 eligible RCTs with 4309 patients were included in the network meta-analysis (NMA). There were no differences in overall morbidity between open gastrectomy (OG) and laparoscopic-assisted gastrectomy (LAG) odds ratio (OR) 1.09, 95% credible interval (Crl): 0.86-1.64, OG and robotic gastrectomy (RG) (OR 1.16, 95% Crl: 0.43-3.07), LAG and totally laparoscopic gastrectomy (TLG) (OR 2.85, 95% Crl: 0.67-12.52), RG and LAG (OR 0.96, 95% Crl: 0.36-2.93), TLG and OG (OR 0.32, 95% Crl: 0.07-1.38) and TLG and RG (OR 0.35, 95% Crl: 0.06-2.01). There were also no differences in the number of HLNs between OG and LAG weighted mean difference (WMD) 0.91, 95% Crl: -0.24-2.43), OG and RG (WMD 1.55, 95% Crl: -2.58-5.51), LAG and TLG (WMD -0.90, 95% Crl: -6.82-5.18), RG and LAG (WMD -0.68, 95% Crl: -4.63-3.91), TLG and OG (WMD -0.01, 95% Crl: -6.41-5.90) and TLG and RG (WMD 1.56, 95% Crl: -6.01-8.59). From the results of the rank probabilities of the four surgical treatments, TLG had the highest probability of being the safest and the most effective surgical approaches. Conclusions: The four surgical treatments of GC have similar safety and efficacy. TLG had the best chance of becoming the safest and most effective treatment. Background Gastric cancer (GC) remains an important cancer worldwide, with more than 1,000,000 new cases in 2018, of which an estimated 783,000 deaths, making it the fifth most commonly diagnosed cancer and the third leading cause of cancer death [1]. Japanese gastric cancer treatment guidelines indicated that distal gastrectomy with D2 lymph node dissection via an open approach is the current 3 standard for advanced gastric cancer (AGC) located in the lower or middle third of the stomach [2]. With the rapid development of laparoscopic instruments and techniques, laparoscopy-assisted distal gastrectomy (LADG) can be used for AGC treatment [3] . Several retrospective studies have demonstrated that totally laparoscopic distal gastrectomy (TLDG) was safer, more feasible, and less invasive than LADG [4] [5] [6] [7] . Additionally, Patriti et al. [8] indicated that robot-assisted laparoscopic gastrectomy with D2 lymph node dissection for adenocarcinoma was feasible and safe. Despite four strategies being available: (OG, LAG, TLG, and RG), some of the surgical treatments have never been compared to each other because of the lack of head-to-head trials. Meanwhile, the traditional meta-analysis has some limitations. Thus, the optimum surgical approach for GC is still unknown. We performed a meta-analysis of RCTs by using NMA as a methodology [9] . Safety was used as the primary endpoint and efficacy was used as the secondary endpoint. Overall morbidity was defined as within 30 days of surgery. Methods Literature screening was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart [10] and the report of the International Society for Pharmacoeconomics and Outcomes Research Task Force on Indirect Treatment Comparisons Good Research Practices [11] . Institutional review board approval was not required. Search Strategy PubMed, Embase, ISI-Web of Science and Cochrane Library were searched for RCTs published between 1950 and 2019. The following terms were used in combinations: Gastric cancer, Stomach
doi:10.21203/rs.2.11859/v1 fatcat:3a7vutcyk5gzpnsa2p575warai