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Panin S.I.
Volgograd State Medical University
Postolov M.P.
Volgograd State Medical University;
Volgograd Regional Clinical Oncology Dispensary
Kovalenko N.V.
Volgograd State Medical University;
Volgograd Regional Clinical Oncology Dispensary
Beburishvili A.G.
Volgograd State Medical University
Fedorov A.V.
Vishnevsky National Medical Research Center for Surgery;
Russian Society of Surgeons
Bykov A.V.
Volgograd State Medical University
Distal subtotal gastrectomy and gastreectomy in surgical treatment of patients with gastric cancer: a systematic review and meta-analysis
Journal: Pirogov Russian Journal of Surgery. 2020;(11): 93‑100
Views: 2841
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To cite this article:
Panin SI, Postolov MP, Kovalenko NV, Beburishvili AG, Fedorov AV, Bykov AV. Distal subtotal gastrectomy and gastreectomy in surgical treatment of patients with gastric cancer: a systematic review and meta-analysis. Pirogov Russian Journal of Surgery.
2020;(11):93‑100. (In Russ.)
https://doi.org/10.17116/hirurgia202011193
To analyze the randomized controlled trials (RCTs) devoted to distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer.
RCTs were searched in the electronic library, the Cochrane Community database, and PubMed database. A systematic review and meta-analysis were carried out in accordance with the recommendations of the Cochrane Community experts (Higgins et al. 2019). Mathematical calculations of a meta-analysis were made using RevMan 5.3 software package. Statistical criteria were calculated for relative risk (RR), hazard ratio (HR), 95% confidence interval (95% CI) and significance level (p).
Seven primary RCTs were selected. A total number of 1463 surgical interventions with D2 lymphadenectomy were observed (805 patients underwent distal subtotal gastrectomy, 658 — gastrectomy). Postoperative mortality is significantly higher (6.5% and 2.6%) after gastrectomy compared to subtotal distal gastrectomy (RR 2.2, 95% CI 1.34—3.64, I2 0%, fixed effect model). Postoperative complications are also significantly more common (28% and 14%) after gastrectomy (RR 1.72, 95% CI 1.16—2.55, I2 heterogeneity 49%, random effect model). Differences in overall five-year survival after gastrectomy and subtotal distal resection (51.6% and 60.8%) are insignificant (HR 0.74, 95% CI 0.45—1.22, I2 90%, random effect model, general reverse inversion).
The choice of distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer is not regulated by evidence-based medicine. The boundaries of minimal surgical clearance from the tumor edge vary from 2.5 cm to 6 cm. An updated meta-analysis shows that postoperative mortality and morbidity are significantly higher after gastrectomy compared to distal subtotal gastrectomy while overall 5-year survival is similar.
Keywords:
Authors:
Panin S.I.
Volgograd State Medical University
Postolov M.P.
Volgograd State Medical University;
Volgograd Regional Clinical Oncology Dispensary
Kovalenko N.V.
Volgograd State Medical University;
Volgograd Regional Clinical Oncology Dispensary
Beburishvili A.G.
Volgograd State Medical University
Fedorov A.V.
Vishnevsky National Medical Research Center for Surgery;
Russian Society of Surgeons
Bykov A.V.
Volgograd State Medical University
Received:
28.11.2019
Accepted:
25.12.2019
List of references:
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