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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

Authors:

Panin S.I., Postolov M.P., Kovalenko N.V., Beburishvili A.G., Fedorov A.V., Bykov A.V.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2020;(11): 93‑100

DOI: 10.17116/hirurgia202011193

Read: 3813 times

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Table of contents

DISTAL SUBTOTAL GASTRECTOMY AND GASTREECTOMY IN SURGICAL TREATMENT OF PATIENTS WITH GASTRIC CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
DISTAL SUBTOTAL GASTRECTOMY AND GASTREECTOMY IN SURGICAL TREATMENT OF PATIENTS WITH GASTRIC CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

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

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

OBJECTIVE

To analyze the randomized controlled trials (RCTs) devoted to distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer.

MATERIAL AND METHODS

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).

RESULTS

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).

CONCLUSION

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:

gastric cancer
meta-analysis
gastrectomy

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

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References:

  1. Klinicheskie rekomendatsii. Rak zheludka. Accessed November, 2019. (In Russ.). https://oncology-association.ru/docs/rak_zheludka.pdf
  2. Stilidi IS, Nered SN, Glukhov EV. Metastatic lymph nodes in the gates of the spleen in cancer of the stomach as a factor of unfavorable prognosis. Journal of N.N. Blokhin Russian Cancer Research Center». 2017;28(3-4):43-48. (In Russ.).
  3. Karachun AM, Pelipas YuV, Sapronov PA, Kozlov OA, Asadchaya DP. Prospective non-randomized case-control study: immediate results of radical laparoscopic interventions for gastric cancer, the experience of a single center. Problems in oncology. 2017;63(2):247-255. (In Russ.). https://doi.org/10.18722/VO2017632247-255
  4. Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501. Journal of Clinical Oncology. 2004;22:2767-2773. https://doi.org/10.1200/JCO.2004.10.184
  5. Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. New England Journal of Medicine. 2008;359:453-462.  https://doi.org/10.1056/nejmoa0707035
  6. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: Interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol. 2004;30:303-308.  https://doi.org/10.1016/j.ejso.2003.11.020
  7. Degiuli M, Sasako M, Ponti A. Italian Gastric Cancer Study Group. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. British Journal of Surgery. 2010;97:643-649.  https://doi.org/10.1002/bjs.6936
  8. Degiuli M, Sasako M, Ponti A, Vendrame A, Tomatis M, Mazza C, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer. British Journal of Surgery. 2014;101:23-31.  https://doi.org/10.1002/bjs.9345
  9. Yang SH, Zhang YC, Yang KH, Li YP, He XD, Tian JH, et al. An evidence-based medicine review of lymphadenectomy extent for gastric cancer. American Journal of Surgery. 2009;197:246-251.  https://doi.org/10.1016/j.amjsurg.2008.05.001
  10. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Metaanalysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Annals of Surgery. 2011;253:900-911.  https://doi.org/10.1097/SLA.0b013e318212bff6
  11. Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, et al. A meta analysis of D1 versus D2 lymph node dissection. Gastric Cancer. 2012;15(1):60-69.  https://doi.org/10.1007/s10120-011-0110-9
  12. Jiang L, Yang KH, Guan QL, Zhao P, Chen Y, Tian JH. Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: a meta analysis. Journal of Surgical Oncology. 2013;107:807-814.  https://doi.org/0.1002/jso.23325
  13. Jiang L, Yang KH, Chen Y, Guan QL, Zhao P, Tian JH. Systematic review and meta-analysis of the effectiveness and safety of extended lymphadenectomy inpatients with resectable gastric cancer. British Journal of Surgery. 2014;101:595-604.  https://doi.org/10.1002/bjs.9497
  14. El-Sedfy A, Dixon M, Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, et al. Personalized surgery for gastric adenocarcinoma: a meta-analysis of D1 versus D2 lymphadenectomy. Annals of Surgical Oncology. 2014;22:1820-1827. https://doi.org/10.1245/s10434-014-4168-6
  15. Mocellin S, McCulloch P, Kazi H, Gama-Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database of Systematic Reviews. 2015;8:CD001964. https://doi.org/10.1002/14651858.CD001964.pub4
  16. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Accessed November 19, 2019. www.training.cochrane.org/handbook
  17. Review Manager. RevMan 5 download and installation. Accessed November 19, 2019. https://community.cochrane.org/tools/review-production-tools/revman-5/revman-5-download
  18. Sovtsov SA, Fedorov AV. Terminology and classification of types of surgical interventions. Continuation of the discussion. Khirurg. 2019;7:79-83. (In Russ.).
  19. Omel’yanovskii VV. i dr. Metodicheskie rekomendatsii po provedeniyu meta-analiza. M. 2017. (In Russ.).
  20. Sullivan GM, Feinn R. Using effect size — or why the P value is not enough. J Grad Med Educ. 2012;4:279-282.  https://doi.org/10.4300/JGME-D-12-00156.1
  21. Qi J, Zhang P, Wang Y, Chen H, Li Y. Does total gastrectomy provide better outcomes than distal subtotal gastrectomy for distal gastric cancer? A systematic review and meta-analysis. PLoS One. 2016;11:e0165179. https://doi.org/10.1371/journal.pone.0165179
  22. Kong L, Yang N, Shi L, Zhao G, Wang M, Zhang Y. Total versus subtotal gastrectomy for distal gastric cancer: meta-analysis of randomized clinical trials. Onco Targets Ther. 2016;9:6795-6800. https://doi.org/10.2147/OTT.S110828
  23. Li Z, Bai B, Xie F, Zhao Q Distal versus total gastrectomy for middle and lower-third gastric cancer: A systematic review and meta-analysis. Int J Surg. 2018;53:163-170.  https://doi.org/10.1016/j.ijsu.2018.03.047
  24. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, et al. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group. Ann Surg. 1997;226:613-620.  https://doi.org/10.1097/00000658-199711000-00006
  25. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg. 1999;230:170-178.  https://doi.org/10.1097/00000658-199908000-00006
  26. Galizia G, Lieto E, De Vita F, et al. Modified versus standard D2 lymphadenectomy in total gastrectomy for nonjunctional gastric carcinoma with lymph node metastasis. Surgery. 2015;157:285-296.  https://doi.org/10.1016/j.surg.2014.09.012
  27. Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet. 1996;347:995-999.  https://doi.org/10.1016/s0140-6736(96)90144-0
  28. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long term results of the MRC randomized surgical trial. British Journal of Cancer. 1999;79:1522-1530. https://doi.org/10.1038/sj.bjc.6690243
  29. Bonenkamp JJ, van de Velde CJH, Sasako M, Hermans J. R2 compared with R1 resection for gastric cancer: morbidity and mortality in a prospective, randomised trial. Eur J Surg. 1992;158(8):413-418. 
  30. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345(8952):745-748.  https://doi.org/10.1016/s0140-6736(95)90637-1
  31. Bunt AMG, Hermans J, Cornelis JH, van de Velde CJH, Sasako M, Hoefsloot FAM, et al. Lymph node retrieval in a randomised trial on Western-type versus Japanese-type surgery in gastric cancer. Journal of Clinical Oncology. 1996;14:2289-2294. https://doi.org/10.1200/JCO.1996.14.8.2289
  32. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. Extended lymph-node dissection for gastric cancer. New England Journal of Medicine. 1999;340:908-914.  https://doi.org/10.1056/NEJM199903253401202
  33. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. Journal of Clinical Oncology. 2004;22:2069-2077. https://doi.org/10.1200/JCO.2004.08.026
  34. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide DutchD1 D2 trial. Lancet Oncology. 2010;11:439-449.  https://doi.org/10.1016/s1470-2045(10)70070-x
  35. Robertson CS, Chung SC, Woods SD, Griffin SM, Raimes SA, Lau JT, et al. A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Annals of Surgery. 1994;220:176-182.  https://doi.org/10.1097/00000658-199408000-00009
  36. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. British Journal of Surgery. 2004;91:283-287.  https://doi.org/10.1002/bjs.4433
  37. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncology. 2006;7:309-315.  https://doi.org/10.1016/S1470-2045(06)70623-4
  38. Dent DM, Madden MV, Price SK. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma. British Journal of Surgery. 1988;75:110-112.  https://doi.org/10.1002/bjs.1800750206
  39. Maeta M, Yamashiro H, Saito H, Katano K, Kondo A, Tsujitani S, et al. A prospective pilot study of extended (D3) and superextended para-aortic lymphadenectomy (D4) in patients with T3 or T4 gastric cancer managed by total gastrectomy. Surgery. 1999;125:325-331.  https://doi.org/10.1067/msy.1999.95974
  40. Kulig J, Popiela T, Kolodziejczyk P, Sierzega M, Szczepanik A. Standard D2 versus extended D2 (D2+) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial. American Journal of Surgery. 2007;193:10-15.  https://doi.org/10.1016/j.amjsurg.2006.04.018
  41. Yonemura Y, Wu CC, Fukushima N, Honda I, Bandou E, Kawamura T, et al. Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer. International Journal of Clinical Oncology. 2008;13:132-137.  https://doi.org/10.1007/s10147-007-0727-1
  42. Sugoor P, Shah S, Dusane R, Desouza A, Goel M, Shrikhande SV. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg. 2016;401:68-697.  https://doi.org/10.1007/s00423-016-1422-3
  43. Cuschieri SA, Hanna GB. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma: let us move on to another era. Annals of Surgery. 2014;259:e90. 
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