STOMACH
Οriginal Paper
Total vs. Proximal Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis Lei Wen1, Xin-Zu Chen1, Bin Wu1, Xiao-Long Chen1,3, Li Wang2, Kun Yang1, Bo Zhang1, Zhi-Xin Chen1, Jia-Ping Chen1, Zong-Guang Zhou1,Chun-Mei Li4 and Jian-Kun Hu1 Department of Gastrointestinal Surgery and 2Chinese Cochrane Center, West China Hospital, Sichuan University, China 3 Faculty of Medicine, West China School of Medicine, Sichuan University, China 4 Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, China 1
Corresponding author: A/Prof. Chun-Mei Li, M.D., Ph.D., Department of Gynecology and Obstetrics , West China Second University Hospital, Sichuan University, Chengdu 610041, China; E-mail:
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ABSTRACT Background/Aims: To compare effectiveness between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer. Methodology: PubMed, Embase, Cochrane library and Chinese CNKI databases were searched to select eligible studies comparing TG to PG for proximal gastric cancer. Outcome measures included overall survival, recurrence, mortality and morbidity rates, as well as nutritional states. Meta-analyses were performed by RevMan 5.0. Results: One randomized controlled trial and 7 retrospective studies involving 1077 patients were included. Meta-analysis showed no significant difference of 5-year overall survival rate (OR=0.89, p=0.53). However, TG achieved a lower recurrence rate (Peto OR=0.53, p=0.004). PG experienced higher morbidi-
INTRODUCTION Gastric cancer remains a world-wide cancer with a high mortality rate (1). In North American and some European countries, carcinoma of the cardia is the primary cancer type of gastric cancer, while there has been a tendency of incidence transmitting from distal toward proximal gastric cancer in Asia in recent years (2). Cancer-related death incidence of proximal gastric cancer is higher than that of other sites of cancer of the stomach (3). Proximal gastric cancer refers to cancers locating in gastric cardia and the upper third of stomach. There are two different stomach resection types for proximal gastric cancer by surgical treatment: total gastrectomy (TG) and proximal gastrectomy (PG). Usually, the decision of GI surgeons depends on tumor size, tumor stage and volume of the remnant stomach. As common knowledge, TG can achieve a longer tumor-free distal resection margin and more radical lymphadenectomy, which seems to have a better curative effect (4). The newly published “Japanese Gastric Cancer Treatment Guidelines 2010” recommends that PG is only suitable for some early stage diseases (5). However, in most retrospective studies, TG had hardly showed superior results in this poor-outcome cancer compared to PG (6-9). Also, anemia and weight loss are frequent postoperative complications in TG patients, which have to be considered (10). Thus, the optimal extent of stomach resection for proxiHepato-Gastroenterology 2012; 59:00-00 doi 10.5754/hge11834 © H.G.E. Update Medical Publishing S.A., Athens
ty risk (OR=0.11, p
