Comparison of short-term outcomes between totally minimally invasive and minimally invasive-assisted Billroth-II gastrectomy for distal gastric cancer: A systematic review and meta-analysis

INTRODUCTION: Minimally invasive Billroth-II distal gastrectomy is one of the most frequently recommended curative resections for patients with lower- and middle-third gastric cancer. However, the efficiency and benefits of totally minimally invasive and minimally invasive-assisted distal gastrectomy with Billroth-II anastomosis are still controversial. This meta-analysis was conducted to compare the short-term outcomes of the two surgical procedures. PATIENTS AND METHODS: We conducted an internet search of the PubMed, Web of Science, Cochrane Medline and Embase databases up to May 2023. The parameters related to surgical outcomes, post-operative recovery, post-operative complications and surgical stress response were subjected to subsequent statistical calculations. Review Manager 5.3 software was used to perform the meta-analysis. RESULTS: A total of seven retrospective studies were included in this meta-analysis. No significant differences were observed in the operative time, number of anastomoses, number of retrieved lymph nodes or surgical stress response indices of white blood cells and C-reactive protein. We detected a lower estimated blood loss, a shorter incision, an earlier time to first flatus and a shorter post-operative hospital stay in patients who underwent totally minimally invasive Billroth-II distal gastrectomy. CONCLUSION: Compared with minimally invasive-assisted Billroth-II distal gastrectomy, totally minimally invasive Billroth-II distal gastrectomy is a feasible and safe radical operation with acceptable surgical outcomes that may offer shorter post-operative recovery times.