title: Total versus subtotal gastrectomy for distal gastric cancer: meta-analysis of randomized clinical trials.
abstract: OBJECTIVE
  This meta-analysis of randomized controlled trials was conducted to give a more precise estimation of the efficacy and drawbacks of total gastrectomy (TG) versus subtotal gastrectomy (SG) for proven distal gastric cancer.
  
  
  METHODS
  The electronic databases Cochrane and PubMed (updated on April 10, 2016) were searched for randomized controlled trials comparing TG with SG as surgical procedures for distal gastric cancer. Five outcome variables were analyzed, including postoperative complications, anastomotic fistula rate, hospital mortality rate, mortality rate of recurrence (the patient's death is caused by the recurrence of gastric cancer, rather than caused by other diseases), and 5-year survival rate. Random or fixed effect model was used to perform this meta-analysis.
  
  
  RESULTS
  Six trials, including 573 cases treated with TG and 791 cases treated with SG, were included. Compared with patients in the SG group, patients in the TG group did not show a higher rate of postoperative complications (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.71-3.03,P=0.30). However, patients in the TG group showed a significantly higher rate of anastomotic fistula than patients in the SG group (OR: 3.78, 95% CI: 1.97-7.27,P<0.0001). Hospital mortality rate, which was analyzed in four trials, including 510 TG versus 729 SG patients, showed no significant difference between the two groups (OR: 1.80, 95% CI: 0.85-3.78,P=0.12). Importantly, there was no significant difference in the 5-year survival between the two groups (OR: 0.68, 95% CI: 0.39-1.19,P=0.18). Mortality rate of recurrence, which was also analyzed in three trials, including 396 TG versus 407 SG patients, showed a significantly higher rate in the TG group (OR: 0.07, 95% CI: 0.01-0.13,P=0.03).
  
  
  CONCLUSIONS
  This meta-analysis demonstrated that postoperative complications, hospital mortality rate, and 5-year survival rate in TG patients was similar to the SG group. Furthermore, SG was associated with significantly fewer anastomotic fistula and lower mortality rate of recurrence compared with TG. However, lower mortality rate of recurrence was probably related to the criteria of these two procedures.
authors.affiliation: Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Lingling
authors.initials: L
authors.lastname: Kong
authors.affiliation: Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Nianzhao
authors.initials: N
authors.lastname: Yang
authors.affiliation: Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Lianghui
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Guohai
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Minghai
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of General Surgery, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China.
authors.forename: Yisheng
authors.initials: Y
authors.lastname: Zhang
keywords: gastric cancer; randomized controlled trials; subtotal gastrectomy; total gastrectomy