Meta analysis of total versus proximal gastrectomy for proximal gastric cancer

Abstract:

Objective：To assess the value of proximal gastrectomy（PG） and total gastrectomy（TG） in the treatment of proximal gastric cancer. Methods：Studies comparing TG to PG for proximal gastric cancer were collected. Outcome measures included harvested LNs，blood loss，operation time，postoperative complication，mortality，5-year overall survival rate，recurrence rate as well as nutritional states. Meta analysis was performed by RevMan 5.0. Results：Twenty five researches were included in these studies. Three of which were randomly controlled studies. There was no significant differences in postoperative complication（OR=1.93，95%CI＝0.97 to 3.85，P=0.060），anastomotic leak（OR=0.74，95%CI=0.31 to 1.76，P=0.490），intestinal obstruction（OR=0.45，95%CI=0.13 to 1.50，P=0.190），reflux esophagitis（OR=4.82，95%CI=0.94 to 24.62，P=0.060），recurrence rate（OR=2.45，95%CI=0.96 to 6.25，P=0.060），5-year over－all survival rate（OR=1.03，95%CI=0.55 to 1.93，P=0.930），mortality（OR=1.35，95%CI=0.73 to 2.50，P=0.340）. While there were significant differences in the harvested LNs（WMD=-11.14，95%CI=-17.81 to -4.48，P=0.001），blood loss（WMD=-425.60，95%CI= -559.75 to -291.46，P=0.000），operation time（WMD=-37.24，95%CI=-62.76 to -11.72，P=0.004），anastomotic stenosis（OR=2.65，95%CI=1.11 to 6.33，P=0.030）. Harvested LNs and anastomotic stenosis in TG group were better than those in PG group；blood loss and operation time in PG group were better than those in TG group. Conclusion：TG has better long-term therapetic effect. in the treatment of proximal gastric cancer.