الفهرس 
ANATOMY OF THE STOMACHOnly 14 pages are availabe for public view
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Abstract
G
astric cancer is the fifth most prevalent type of cancer and the third deadliest tumor that leads to death, as globally, about one million cases of stomach cancer were diagnosed in 2018, and the number of deaths due to stomach cancer is close to 783,000 deaths.
Radical resection of the tumor with evacuation of the lymph nodes is the optimal and effective treatment for stomach cancer, which is associated with an increased survival rate. Surgical gastrectomy remained the primary treatment approach for stomach cancer for a long time until 1994. Endoscopy was used for cases of early stomach cancer.
Gastric resection using laparoscopy is characterized by simple cosmetic wounds compared to exploratory laparotomy. It is also characterized by reducing pain and short hospital stay. Therefore, this operation using laparoscopy has spread widely in Korea and Japan, especially in the early stages of stomach cancer.
The resection of the stomach using a surgical endoscope is one of the complex surgeries that requires great skill and continuous training, as emptying the lymph nodes surrounding the stomach with safe edges resection and reconnecting the intestine is the most accurate and essential step that is related to the efficiency of the radical removal of the tumor and therefore increases the rates of recovery and survival and reduces the chances of reflux Tumor.
Therefore, this systematic study and meta-analysis was conducted to review the difference between open and laparoscopic D2 gastrectomy in patients with locally advanced gastric cancer in terms of feasibility and radicality. In addition to evaluate the surgical outcomes, postoperative complications.
We followed the PRISMA statement guidelines during this systematic review and meta-analysis preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Cochrane, Web of Science, nature, and Google scholar from 2017 tills September 2022 relevant keywords. We used the following search strategy for searching different databases: (”Gastric cancer” OR ”Stomach neoplasms”) AND (”D2 gastrectomy” OR ”D2 lymphadenectomy”OR ”Locally advanced gastric cancer”) OR (”Open D2 gastrectomy” AND ”Laparoscopic D2 gastrectomy”) AND (”Early postoperative complications” OR ”Surgical margins” OR ”Harvest lymph nodes” OR ”Pathological outcome”).
Our results showed that the overall of operative time (min) duration was significantly shorter for OD2G compared to LD2G. On the other hand, our meta-analysis showed that the mean difference for blood loss was significantly higher for ODG.
The overall effect of mean difference for first flatus (days) and first oral intake (days) for Laparoscopic versus open D2 gastrectomy was reported in 10 studies, was significantly shorter in the LD2G compared to OD2G.
With respect to pathological outcomes the overall effect was showed a non-significant risk difference between LD2G compared to LD2G for distal and total gastrectomy. The number of HLNs is regarded as an important short-term oncological outcome of laparoscopic D2 dissection. Our result showed that there is no significant difference between LD2G and OD2G.
The overall effect for the rate of positive lymph nodes for Laparoscopic versus open D2 gastrectomy was significantly shorter in the LD2G compared to OD2G.
The overall effect of Proximal resection margin (cm), and the tumor size (cm) showed a non-significant mean difference between LD2G compared to OD2G.
According to the findings of the current meta-analysis, utilizing laparoscopic with D2 lymph node dissection is a safe and practical procedure for treating patients with advanced gastric cancer since it results in less blood loss, a faster recovery after surgery, equivalent postoperative complications, and similar oncological safety.
CONCLUSION
E
arly post-operative coarse and pathological outcome for Meta-Analysis of laparoscopic vs open D2 gastrectomy in managing locally advanced gastric cancer were used in this Meta-analysis. Our study could be concluded that laparoscopic D2 dissection is safe, with less blood loss than open surgery, reduced postoperative complications, and the number of harvested lymph nodes non- significant between laparoscopic D2 and open surgery.
Finally, utilizing laparoscopic with D2 lymph node dissection is a safe and practical procedure for treating patients with advanced gastric cancer since it results in less blood loss, a faster recovery after surgery, equivalent postoperative complications, and similar oncological safety.