Two-dimensional versus three-dimensional laparoscopic gastrectomy in surgical efficacy for gastric cancer: a systematic review and meta-analysis

The surgical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic gastrectomy for gastric cancer remains controversial. A meta-analysis with all eligible studies was conducted to explore the surgical efficacy of 2D versus 3D laparoscopic gastrectomy for gastric cancer. A systematic search was performed. The weighted mean difference (WMD) or odds risk (OR) of patients with 2D or 3D laparoscopic gastrectomy were used to calculate surgical efficacy of 3D and 2D laparoscopic gastrectomy for gastric cancer. Ten studies involving 1478 patients who underwent 2D or 3D laparoscopic gastrectomy were identified. Three-dimensional laparoscopic gastrectomy decreases operation time (WMD: − 16.517, 95% CI − 25.550 to − 7.484, P = 0.000), intraoperative blood loss (WMD: − 21.060, 95% CI − 32.209 to − 9.911, P = 0.000) and number of retrieved lymph nodes (WMD: 3.699, 95% CI 1.838–5.560, P = 0.000) compared with 2D laparoscopic surgery. However, no differences in time to first postoperative flatus (WMD: − 0.119, 95% CI − 0.330 to − 0.092, P = 0.269), perioperative complications (OR: 0.901, 95% CI 0.649–1.251, P = 0.534), or hospital stay (WMD: − 0.624, 95% CI − 1.983 to 0.735, P = 0.368) were noted between 3D and 2D laparoscopic gastrectomy for gastric cancer. 3D laparoscopic gastrectomy decreases the operation time, intraoperative blood loss, and numbers of retrieved lymph nodes compared with 2D laparoscopic gastrectomy for gastric cancer.