Effect of Minimally Invasive versus Open Distal Gastrectomy on Long-Term Survival in Patients with Gastric Cancer: Individual Patient Data Meta-analysis

Background Minimally invasive distal gastrectomy (MIDG) has been shown to improve short-term outcomes compared with open distal gastrectomy (ODG) in patients with early (EGC) and locally advanced gastric cancer (LAGC). The impact of MIDG on patient survival remains debated. This study aimed to compare the effect of MIDG versus ODG on long-term survival. Patients and Methods Randomized clinical trial (RCTs) individual patient data (IPD) meta-analysis with restricted mean survival time difference (RMSTD) estimation. Scopus, MEDLINE, Web of Science, and ClinicalTrials.gov were searched. Primary outcomes were 5-year overall (OS), disease free survival (DFS), and cancer specific survival (CSS). RMSTD and 95% confidence intervals (CI) were used as pooled effect size measures. The certainty of evidence was categorized with the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results Overall, ten RCTs (5297 patients) were included; 50.4% of patients underwent MIDG. At 60-months follow-up, the OS and DFS estimates for ODG versus MIDG were 0.41 months (95% CI − 0.17, 0.99; high level of certainty) and 0.42 months (95% CI − 0.38, 1.23; high level of certainty). CSS was specified in two RCTs, hence quantitative analysis was not practicable. The 60-month OS and DFS estimates for LAGC (five studies) were 0.32 months (95% CI − 0.80, 1.44; high level of certainty) and 0.31 months (95% CI − 2.02, 1.33; high level of certainty), respectively. The 36-month DFS appraisal for stage III patients (three studies) was − 0.41 months (95% CI − 26.1, 38.2; low level of certainty). Conclusions This meta-analysis found high-certainty evidence that MIDG and ODG demonstrate similar 5-year OS and DFS in patients with both EGC and LAGC.