Subtotal versus total gastrectomy for remnant gastric cancer: a systematic review and meta-analysis of observational studies

Published on Mar 10, 2021in Langenbeck's Archives of Surgery2.184
· DOI :10.1007/S00423-021-02144-6
Ryota Otsuka7
Estimated H-index: 7
(Chiba University),
Koichi Hayano14
Estimated H-index: 14
(Chiba University)
+ 4 AuthorsHisahiro Matsubara58
Estimated H-index: 58
(Chiba University)
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.
#1Honghu Wang (PRC: China Medical University (PRC))H-Index: 1
#2Hao Qi (PRC: China Medical University (PRC))H-Index: 1
Last. Kai Li (PRC: China Medical University (PRC))H-Index: 7
view all 7 authors...
The staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retriev...
1 CitationsSource
#1Tsz Kin Mak (JNU: Jinan University)H-Index: 2
#2Bingsheng Guan (JNU: Jinan University)H-Index: 6
Last. Jingge Yang (JNU: Jinan University)H-Index: 10
view all 7 authors...
The incidence and outcomes of GRC remain variable. Minority published researches have paid attention to the characteristics of GRC. This study aimed to make a systematic review and meta-analysis of the prevalence of GRC, with a focus on characteristics and survival rates of GRC. PubMed, EMBASE, and CENTRAL were searched for related clinical studies. Data were pooled using Stata 11.0, and subgroup and sensitivity analyses were performed if necessary and feasible. Moreover, SPSS (version 19.0) was...
4 CitationsSource
#1C. Y. Kung (Taipei Veterans General Hospital)H-Index: 1
#2Wen-Liang Fang (Taipei Veterans General Hospital)H-Index: 18
Last. Kuo-Hung Huang (Taipei Veterans General Hospital)H-Index: 24
view all 9 authors...
Background Gastric stump ("remnant") cancer is the development of a malignancy related to previous gastric surgery. Prognosis in gastric stump cancer, compared with that in primary gastric cancer, is still controversial. Methods From January 1988 to December 2012 at a single medical centre in Taiwan, 105 patients with gastric stump cancer, including 85 with previous peptic ulcer disease and 20 with previous gastric cancer, were analyzed for clinicopathologic characteristics and overall survival ...
1 CitationsSource
#1Fuhai Ma (Peking Union Medical College)H-Index: 6
#2Yang Li (Peking Union Medical College)H-Index: 4
Last. Yantao Tian (Peking Union Medical College)H-Index: 2
view all 12 authors...
BACKGROUND: Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions. METHODS: A total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients ...
2 CitationsSource
#1Hironobu GotoH-Index: 3
#2Shingo Kanaji (Kobe University)H-Index: 14
Last. Yoshihiro Kakeji (Kobe University)H-Index: 65
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Purpose Completion gastrectomy (CG) is a common procedure for remnant gastric cancer (RGC). However, partial gastrectomy for gastric cancer has several benefits compared to total gastrectomy in terms of the quality of life. In this study, we evaluated the feasibility and advantage of subtotal resection of the remnant stomach (SR) for clinical stage IA RGC.
4 CitationsSource
#1Ryota Otsuka (Chiba University)H-Index: 7
#2Hideki Hayashi (Chiba University)H-Index: 34
Last. Hisahiro Matsubara (Chiba University)H-Index: 58
view all 11 authors...
Aim: Application of laparoscopic approaches for the treatment of remnant gastric cancers (RGC) is still controversial. Therefore, in the present study, the safety and effectiveness of laparoscopic gastrectomy (LG) for RGC was investigated. Methods: A total of 27 patients who underwent gastrectomy for RGC from June 2008 to September 2017 were enrolled in this study. A comprehensive review of the literature on LG for RGC published before December 2017 using the PubMed database was carried out. Res...
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Quality of life after total vs distal gastrectomy with Roux-en-Y reconstruction: Use of the Postgastrectomy Syndrome Assessment Scale-45
13 CitationsSource
#1Jin Qi (Lanzhou University)H-Index: 1
#2Zhang PengH-Index: 3
Last. Yumin Li (Lanzhou University)H-Index: 9
view all 5 authors...
Background/Aims Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored. Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer. Methodology A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through...
20 CitationsSource
#1Sang-Yong Son (Seoul National University Bundang Hospital)H-Index: 17
#2Chang Min Lee (Seoul National University Bundang Hospital)H-Index: 14
Last. Hyung Ho Kim (SNU: Seoul National University)H-Index: 52
view all 7 authors...
Background The aim of the present study was to evaluate the feasibility of laparoscopic completion total gastrectomy (LCTG) in patients with remnant gastric cancer.
27 CitationsSource
The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with ...
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