Comparison of hand-assisted laparoscopic radical gastrectomy and laparoscopic-assisted radical gastrectomy: A systematic review and meta-analysis

BACKGROUND Gastrectomy is the optimal treatment for gastric cancer. Laparoscopic-assisted gastrectomy（LAG） has been extensively employed, while hand-assisted laparoscopic gastrectomy（HALG）, which is similar to LAG, remains controversial. Although HALG is popular in China, some surgeons do not accept it as a minimal-access technique.AIM To assess the safety and practicability of HALG by comparing the short-term outcomes of HALG and LAG.METHODS The electronic databases of EMBASE, Pub Med, China National Knowledge Infrastructure, and Cochrane Library were thoroughly searched, and randomized controlled trials（RCTs） comparing HALG and LAG were included. The study results, including surgery time, blood loss, retrieved lymphatic nodes, incision length, time to first flatus, hospitalization duration, and all postsurgical complications, were compared between the two groups.RESULTS Five RCTs, which included 302 cases with HALG and 298 cases with LAG, were considered eligible for inclusion. Meta-analysis showed that HALG significantly reduced surgery time（P ＜ 0.01）, hospital duration（P ＜ 0.01）, and overall postsurgical complications（P ＜ 0.01）. Additionally, HALG significantly increased the number of retrieved lymphatic nodes（P = 0.01） and incision length（P ＜ 0.01）compared with LAG. The blood loss and time to first flatus were similar between the two groups（P ＞ 0.05）.CONCLUSION Compared with LAG, HALG is a simpler and safer technique. Additionally, HALG should be used as a minimal-access technique, especially in technologically undeveloped areas.