Distal subtotal gastrectomy and gastreectomy in surgical treatment of patients with gastric cancer: a systematic review and meta-analysis

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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

SPIN RSCI: 8303-5413
Scopus AuthorID: 57198338379
ORCID: 0000-0003-4086-2054

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

ORCID: 0000-0002-8456-8685

Bykov A.V.

Volgograd State Medical University

SPIN RSCI: 6746-5044
Scopus AuthorID: 7102231435
ORCID: 0000-0002-1505-6256

Received:

28.11.2019

Accepted:

25.12.2019

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