Background/Objectives: Total gastrectomy (TG) is the cornerstone treatment for gastric cancer (GC). While open TG (OTG) with D2 lymphadenectomy remains the gold standard, alternative techniques such as lap-assisted TG (LATG), totally laparoscopic TG (TLTG), and robotic TG (RTG) have been reported with promising outcomes. The present analysis aimed to compare the short-term outcomes of different techniques for TG comprehensively in the setting of GC. Methods: A systematic review and network meta-analysis were performed. The primary outcomes were overall complications (OC), severe postoperative complications (SPCs), and anastomotic leak (AL). Pooled effect-size measures included risk ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrIs). Results: Sixty-eight studies (44,689 patients) were included. Overall, 52.4% underwent OTG, 6.5% LATG, 39.2% TLTG, and 1.9% RTG. Both TLTG (RR 0.82; 95% CrI 0.73–0.92) and RTG (RR 0.75; 95% CrI 0.59–0.95) showed a reduced rate of postoperative OC compared to OTG. SPCs and AL RR were comparable across all techniques. Despite the longer operative time, LATG, TLTG, and RTG showed reduced intraoperative blood loss, time to first flatus, ambulation, liquid diet resumption, and hospital stay compared to OTG. Conclusions: Minimally invasive approaches seem to be associated with improved OC and functional outcomes compared to OTG.
背景/目的：全胃切除术是胃癌治疗的基石。虽然开放式全胃切除术联合D2淋巴结清扫仍是金标准，但腹腔镜辅助全胃切除术、全腹腔镜全胃切除术及机器人全胃切除术等替代技术已显示出良好疗效。本研究旨在全面比较不同全胃切除术式在胃癌治疗中的短期疗效。方法：采用系统综述与网状荟萃分析方法。主要结局指标包括总体并发症发生率、严重术后并发症发生率及吻合口漏发生率。合并效应量指标采用风险比、加权均数差及95%可信区间。结果：共纳入68项研究（44,689例患者）。总体而言，52.4%接受开放式全胃切除术，6.5%接受腹腔镜辅助全胃切除术，39.2%接受全腹腔镜全胃切除术，1.9%接受机器人全胃切除术。与开放式全胃切除术相比，全腹腔镜全胃切除术（风险比0.82；95%可信区间0.73-0.92）和机器人全胃切除术（风险比0.75；95%可信区间0.59-0.95）均显示术后总体并发症发生率降低。各术式在严重术后并发症及吻合口漏发生率方面无显著差异。尽管微创术式手术时间较长，但腹腔镜辅助全胃切除术、全腹腔镜全胃切除术及机器人全胃切除术在术中失血量、首次排气时间、下床活动时间、流质饮食恢复时间及住院时长方面均优于开放式全胃切除术。结论：与开放式全胃切除术相比，微创术式可能改善总体并发症发生率及功能恢复结局。
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