Advancement of single-port and reduced-port laparoscopic gastrectomy for gastric cancer: a systemic review

摘要

Background: Laparoscopic gastrectomy has been established as a surgical treatment option for early gastric cancer. Accumulation of experience performing a variety of laparoscopic surgeries enables surgeons to do less invasive surgery, including reduced port laparoscopic gastrectomy (RPLG) and single port laparoscopic gastrectomy (SPLG), to improve the quality of life in patients with gastric cancer. The aim of this study was to review techniques and outcomes of RPLG and SPLG, and to suggest further directions for minimally invasive gastrectomy. Methods: We searched several databases; MEDLINE/PubMed and EMBASE/Ovid using the following key words: gastrectomy; gastric cancer; laparoscopy, laparoscopic; reduced port; single port, single incision, single site, single, and one. Clinical trials and observational studies reporting RPLG or SPLG were included. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Results: Seven studies for RPLG and three studies for SPLG were included in this review. A total of 532 patients with gastric cancer were included in these studies: 384 in the RPLG studies, 148 in the SPLG studies. There were no significant differences regarding the number of retrieved lymph nodes (LN), length of hospital stay, postoperative diet course or the presence of postoperative complications between either RPLG or SPLG compared to conventional laparoscopic gastrectomy (CLG). RPLG patients had similar postoperative pain and SPLG patients had significantly less compared to CLG patients. Conclusions: RPLG and SPLG can be alternative to CLG, as less invasive approaches with acceptable postoperative outcomes. RPLG or SPLG might be considered as a bridge technique from CLG to robotic single port surgery or natural orifice transluminal endoscopic surgery (NOTES) for patients with gastrectomy.