Totally Laparoscopic Versus Laparoscopy-Assisted Distal Gastrectomy for Early Gastric Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

[BACKGROUND] Totally laparoscopic distal gastrectomy (TLDG) is a minimally invasive alternative to laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. While both are widely used, it remains unclear which yields better outcomes. Therefore, this meta-analysis aimed to compare surgical outcomes and postoperative quality of life (QoL) between TLDG and LADG.

[METHODS] We searched PubMed, Embase, and Cochrane Library databases in May 2025. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with statistics. Statistical analysis was performed using the R software.

[RESULTS] Three studies involving a total of 954 patients were included, of whom 484 underwent TLDG. Compared with LADG, TLDG significantly reduced Clavien-Dindo (CD) grades I-II complications (RR = 0.54; 95% CI: 0.33-0.89) and intraoperative blood loss (MD = -13.97 mL; 95% CI: -23.71, -4.23). Additionally, TLDG was associated with improved postoperative QoL assessed with the Stomach Module questionnaire (QLQ-STO22) (MD = -5.96 points; 95% CI: -11.51, -0.40). No significant differences were found between the groups in CD grades III-IV complications, early complications, operative time, or QoL measured by Quality-of-Life questionnaire. Postoperative mortality was rare, with only one reported death across all studies.

[CONCLUSIONS] TLDG was associated with fewer low-grade complications and less intraoperative blood loss, compared with LADG. However, no significant differences were observed in major complications and operative time. Furthermore, there was an improvement in QoL assessed using the QLQ-STO22 in favor of TLDG. These findings support TLDG as a safe and effective alternative to LADG for early gastric cancer.