Ryota Otsuka1, Koichi Hayano2, Masahiro Yoshida3, Hironobu Goto4, Yusuke Muneoka5, Souya Nunobe5, Hisahiro Matsubara2. 1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. ryotaotsuka@yahoo.co.jp. 2. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 3. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Chiba, Japan. 4. Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan. 5. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Abstract
PURPOSE: Subtotal gastrectomy (SG) has become a general option for distal gastric cancer. However, the availability of an organ-preserving approach for the treatment of remnant gastric cancer (RGC) is still controversial. Thus, the objective of the present study was to assess the safety and efficacy of SG for RGC by integrating data from published articles. METHODS: We searched the PubMed, Cochrane Library, and Web of Science databases for studies that compared SG versus total gastrectomy (TG) for RGC published from the inception of the databases until May 2020. A meta-analysis was performed using the Review Manager Version 5.0 software program from the Cochrane Collaboration. RESULTS: Three retrospective cohort studies with 144 patients were included. The meta-analysis revealed that the operative time of the SG group was significantly shorter than that in the TG group (MD: -34.84. 95% CI: -59.97- -9.71, P = 0.007). There was no significant difference in intraoperative blood loss (MD: -109.19. 95% CI: -240.37-21.99, P =0.10), length of postoperative hospital stay (MD: 0.40. 95% CI: -3.03-3.83, P = 0.82), postoperative complications (RR: 1.41. 95% CI: 0.76-2.63, P = 0.28), or recurrence (RR: 2.33, 95% CI: 0.48-11.44, P = 0.30). SG for RGC tended to be correlated with favorable 5-year overall survival; however, the association was not statistically significant (HR: 0.89, 95% CI: 0.63-1.26, P = 0.51). CONCLUSION: Organ-preserving approaches such as SG may be a safe and feasible treatment option for early-stage RGC.
PURPOSE: Subtotal gastrectomy (SG) has become a general option for distal gastric cancer. However, the availability of an organ-preserving approach for the treatment of remnant gastric cancer (RGC) is still controversial. Thus, the objective of the present study was to assess the safety and efficacy of SG for RGC by integrating data from published articles. METHODS: We searched the PubMed, Cochrane Library, and Web of Science databases for studies that compared SG versus total gastrectomy (TG) for RGC published from the inception of the databases until May 2020. A meta-analysis was performed using the Review Manager Version 5.0 software program from the Cochrane Collaboration. RESULTS: Three retrospective cohort studies with 144 patients were included. The meta-analysis revealed that the operative time of the SG group was significantly shorter than that in the TG group (MD: -34.84. 95% CI: -59.97- -9.71, P = 0.007). There was no significant difference in intraoperative blood loss (MD: -109.19. 95% CI: -240.37-21.99, P =0.10), length of postoperative hospital stay (MD: 0.40. 95% CI: -3.03-3.83, P = 0.82), postoperative complications (RR: 1.41. 95% CI: 0.76-2.63, P = 0.28), or recurrence (RR: 2.33, 95% CI: 0.48-11.44, P = 0.30). SG for RGC tended to be correlated with favorable 5-year overall survival; however, the association was not statistically significant (HR: 0.89, 95% CI: 0.63-1.26, P = 0.51). CONCLUSION: Organ-preserving approaches such as SG may be a safe and feasible treatment option for early-stage RGC.
Authors: James J Mezhir; Mithat Gonen; John B Ammori; Vivian E Strong; Murray F Brennan; Daniel G Coit Journal: Ann Surg Oncol Date: 2010-11-10 Impact factor: 5.344