Proximal gastrectomy versus total gastrectomy for adenocarcinoma of the esophagogastric junction: a meta-analysis

Chen, Yi-Chuan; Lü, Li; Fan, Kaihu; Wang, Daohan; Fu, Weihua

doi:10.2217/cer-2019-0016

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…Concerning neo-/adjuvant therapy, an essential factor for survival, there was no significant difference between the 2 groups. In addition, our study also revealed TG enabled a more completed nodal dissection, which was concordance with all published studies [47, 48]. The extent of lymphadenectomy was another important consideration when TG and PG are compared, especially the dissection of #4d, #5, and #6, which are usually excluded in PG.…”

Section: Discussionsupporting

confidence: 91%

“…Recently, postoperative quality of life has received significant attention in addition to oncological outcomes. This was mainly because the incidence of postgastrectomy disturbances in patients who underwent PG was high as previously reported, including some meta-analyses [17, 29, 47, 48, 50]. In our experience, the PG group showed a higher rate of anastomotic stenosis and reflux symptoms but similar reflux esophagitis when compared with TG.…”

Section: Discussionsupporting

confidence: 71%

“…The published “Japanese Gastric Cancer Treatment Guidelines 2014” commended that PG was only suitable for some certain early stage diseases (such as clinical T1a), while TG should be recommended for advanced PGC to achieve the standard lymph node dissections [46]. On the other hand, some recent meta-analyses showed no significant difference in long-term survival in both early and locally advanced gastric cancer between PG and TG groups in past years [17, 47, 48, 50]. Different from these meta-analyses, our study provided that PG had a prominent improved OS than TG for all gastric cancer patients irrespective of stage, while a similar 5-year OS for only early gastric cancer patients.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

et al. 2020

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Introduction: The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis. Methods: We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes. Results: A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08–4.50]; p = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85–5.99]; p < 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = −10.46 [95% CI: −12.76 to −8.17]; p < 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03–1.77]; p = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59–2.45]; p = 0.62). Conclusion: In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

et al. 2020

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“…While the feasibility and safety of these two methods have been demonstrated in a variety of studies, most of them were singlecenter studies with small sample sizes and limited follow-up periods. Previous meta-analysis relied on data mostly obtained from conventional open surgery (23)(24)(25)(26)(27). To overcome these limitations, a meta-analysis of studies comparing LPG and LTG for proximal gastric cancer should be performed.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

et al. 2021

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BackgroundTo compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer.MethodsOriginal English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer).ResultsFourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = −13.33, 95% CI: −15.66 to −11.00, P < 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = −42.51, 95% CI: −58.99 to −26.03, P < 0.00001), less intraoperative blood loss (WMD = −79.52, 95% CI: −116.63 to −42.41, P < 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG.ConclusionLPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.

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“…Some authors assume that SG may be beneficial and preferable for proximal GC [10,11]. Goto et al reported noninferiority of SG for remnant GC at stage IA disease [12].…”

mentioning

confidence: 99%

The role of subtotal and total gastrectomy in the treatment of gastric cancer

Palaj

Kečkéš

Waczulı́ková

et al. 2021

neo

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The optimal procedure for the lower third gastric adenocarcinoma is still an open question. We performed an analysis of the long-term survival of patients after subtotal (SG) or total gastrectomy (TG) on 164 enrolled patients. Bivariate and multivariable analyses were performed in order to identify characteristics associated with long-term survival. Survival was significantly affected by the number of positive lymph nodes (LN). Patients who have undergone TG had a higher number of total removed LN. The adjusted hazard ratio for the TG group suggests a partial superiority of TG over SG for patients with curative intent. Our data support the importance of extended LN dissection.

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Proximal gastrectomy versus total gastrectomy for adenocarcinoma of the esophagogastric junction: a meta-analysis

Cited by 14 publications

References 31 publications

Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

The role of subtotal and total gastrectomy in the treatment of gastric cancer

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