Journal of gastrointestinal oncology · 2026
Comparison of the efficacy and safety of single-incision versus multi-port laparoscopic D2 lymphadenectomy for locally advanced gastric cancer: a systematic review and meta-analysis.
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Lin Ruijie, Wei Shoujiang
Аннотация
BACKGROUND: As a cutting-edge advancement in the field of minimally invasive surgery, single-incision laparoscopic surgery (SILS) represents a significant evolution from traditional multi-port approaches toward minimizing surgical stress and optimizing cosmetic outcomes in gastrointestinal oncology. This study aimed to compare the efficacy and safety of SILS and multi-port laparoscopic surgery (MPLS) in D2 lymphadenectomy of locally advanced gastric cancer (LAGC) radical surgery, so as to provide an evidence-based basis for clinical operation selection.
METHODS: Following PRISMA 2020, we included studies comparing SILS and MPLS in LAGC patients undergoing D2 lymphadenectomy [PICOS: P: LAGC patients; I: SILS; C: MPLS; O: complications, lymph node yield, survival; S: randomized controlled trials (RCTs) and retrospective studies]. A systematic search was updated through September 2025 in Chinese and English databases. Risk of bias was assessed using Cochrane RoB 2.0 (RCTs) and Newcastle-Ottawa Scale (NOS) (retrospective studies).
RESULTS: A total of 10 articles (6 RCTs and 4 retrospective studies) involving 1,892 patients were analyzed. Stratified analysis by study design showed that in the RCT subgroup (n=6), there were no significant differences in complication rates [odds ratio (OR) =0.87, P=0.18] or the number of lymph nodes dissected [standardized mean difference (SMD) =-0.08, P=0.15]. Results from the retrospective subgroup (n=4) were consistent with those of the RCTs. Across all evidence levels, SILS significantly reduced blood loss (SMD =-0.31, P<0.001) and yielded smaller incision lengths (SMD =-2.41, P<0.001).
CONCLUSIONS: Based on the synthesis of currently available moderate-to-high quality evidence, SILS in LAGC radical resection achieves comparable oncological radicality to MPLS. While SILS significantly enhances perioperative recovery and minimally invasive benefits, the findings are subject to the inherent limitations of the included study designs.
METHODS: Following PRISMA 2020, we included studies comparing SILS and MPLS in LAGC patients undergoing D2 lymphadenectomy [PICOS: P: LAGC patients; I: SILS; C: MPLS; O: complications, lymph node yield, survival; S: randomized controlled trials (RCTs) and retrospective studies]. A systematic search was updated through September 2025 in Chinese and English databases. Risk of bias was assessed using Cochrane RoB 2.0 (RCTs) and Newcastle-Ottawa Scale (NOS) (retrospective studies).
RESULTS: A total of 10 articles (6 RCTs and 4 retrospective studies) involving 1,892 patients were analyzed. Stratified analysis by study design showed that in the RCT subgroup (n=6), there were no significant differences in complication rates [odds ratio (OR) =0.87, P=0.18] or the number of lymph nodes dissected [standardized mean difference (SMD) =-0.08, P=0.15]. Results from the retrospective subgroup (n=4) were consistent with those of the RCTs. Across all evidence levels, SILS significantly reduced blood loss (SMD =-0.31, P<0.001) and yielded smaller incision lengths (SMD =-2.41, P<0.001).
CONCLUSIONS: Based on the synthesis of currently available moderate-to-high quality evidence, SILS in LAGC radical resection achieves comparable oncological radicality to MPLS. While SILS significantly enhances perioperative recovery and minimally invasive benefits, the findings are subject to the inherent limitations of the included study designs.