Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

Abstract

Distal gastrectomy (DG) and total gastrectomy (TG) are the most common types of radical surgery for patients with middle-third gastric cancer (MTGC). However, the indications and benefits of the two procedures still remain controversial. The present meta-analysis aimed to compare the surgical and oncological outcomes of DG and TG in the treatment of MTGC. A rigorous literature review was performed in the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature to retrieve studies published up to February 2022. The Newcastle-Ottawa Scale was used to assess the quality of included studies and a meta-analysis was performed using RevMan 5.3 software. A total of 12 retrospective studies performing comparisons of DG and TG were included in the present meta-analysis. For patients who underwent DG, a lower rate of overall post-operative complications, anastomosis leakage and intro-abdominal infection was determined. No significant difference was observed between DG and TG in the 5-year overall survival when the proximal resection margin ranged from 3 to 5 cm. Although DG was associated with a higher 5-year overall survival rate when compared to TG, there was no significant difference in the stratified analyses by TNM stage. In conclusion, the prognosis of MTGC did not depend on the extent of gastrectomy. With lower complications and acceptable oncological outcomes, DG was a safe and feasible surgical procedure for MTGC when a negative proximal margin was confirmed.

Long-term Results of Totally Laparoscopic Near-total Gastrectomy for Middle-third Gastric Cancer

“…Our findings are noteworthy in terms of the low occurrence of postoperative status and favorable oncological outcomes compared with total gastrectomy. 21 In patients with stage T4 lesions, the incidence of intra-abdominal metastases increased. We observed intra-abdominal metastases in 78.6% (11/14 cases) of patients with T4a lesions.…”

Anastomotic Leakage after Gastrectomy for Gastric Cancer

“…• Distal gastrectomy versus total gastrectomy (open and laparoscopic). A meta-analysis showed better 5-year survival for distal gastrectomy compared to total gastrectomy (55-67% vs 24-61%) and lower AL rate (OR=3.38, p=0.02), despite similar TNM stages [52], suggesting that distal gastrectomy should be preferred whenever possible.…”