Total vs. proximal gastrectomy for proximal gastric cancer: a systematic review and meta-analysis.
OBJECTIVE
To compare effectiveness between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer.


METHODS
PubMed, Embase, Cochrane library and Chinese CNKI databases were searched to select eligible studies comparing TG to PG for proximal gastric cancer. Outcome measures included overall survival, recurrence, mortality and morbidity rates, as well as nutritional states. Meta-analyses were performed by RevMan 5.0.


RESULTS
One randomized controlled trial and 7 retrospective studies involving 1077 patients were included. Meta-analysis showed no significant difference of 5-year overall survival rate (OR=0.89, p=0.53). However, TG achieved a lower recurrence rate (Peto OR=0.53, p=0.004). PG experienced higher morbidity risk (OR=0.11, p<0.00001), concerning higher risks of reflux esophagitis (OR=0.04, p<0.00001) and anastomotic stenosis (OR=0.14, p<0.00001) in a short period. TG performed longer operation time (p=0.002) and more blood loss (p<0.00001). Operative mortality and nutritional states were comparable without significant differences.


CONCLUSIONS
Based on current retrospective evidences, TG and PG had similar overall survival outcome for proximal gastric cancer, but TG showed lower recurrence rate. PG with gastroesophagostomy had higher incidence of reflux esophagitis and anastomotic stenosis. TG can be recommendation for proximal gastric cancer, although more high-quality trials are still expected.
Department of Gastrointestinal Surgery, Sichuan University, China.
Lei
L
Wen
Xin-Zu
XZ
Chen
Bin
B
Wu
Xiao-Long
XL
Chen
Li
L
Wang
Kun
K
Yang
Bo
B
Zhang
Zhi-Xin
ZX
Chen
Jia-Ping
JP
Chen
Zong-Guang
ZG
Zhou
Chun-Mei
CM
Li
Jian-Kun
JK
Hu
D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009752:Nutritional Status; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome