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. 2016 Nov 7:9:6795-6800.
doi: 10.2147/OTT.S110828. eCollection 2016.

Total versus subtotal gastrectomy for distal gastric cancer: meta-analysis of randomized clinical trials

Lingling Kong  1 , Nianzhao Yang  1 , Lianghui Shi  1 , Guohai Zhao  1 , Minghai Wang  1 , Yisheng Zhang  1
Affiliations

Total versus subtotal gastrectomy for distal gastric cancer: meta-analysis of randomized clinical trials

Lingling Kong et al. Onco Targets Ther. .

Abstract

Objectives: This meta-analysis of randomized controlled trials was conducted to give a more precise estimation of the efficacy and drawbacks of total gastrectomy (TG) versus subtotal gastrectomy (SG) for proven distal gastric cancer.

Methods: The electronic databases Cochrane and PubMed (updated on April 10, 2016) were searched for randomized controlled trials comparing TG with SG as surgical procedures for distal gastric cancer. Five outcome variables were analyzed, including postoperative complications, anastomotic fistula rate, hospital mortality rate, mortality rate of recurrence (the patient's death is caused by the recurrence of gastric cancer, rather than caused by other diseases), and 5-year survival rate. Random or fixed effect model was used to perform this meta-analysis.

Results: Six trials, including 573 cases treated with TG and 791 cases treated with SG, were included. Compared with patients in the SG group, patients in the TG group did not show a higher rate of postoperative complications (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.71-3.03, P=0.30). However, patients in the TG group showed a significantly higher rate of anastomotic fistula than patients in the SG group (OR: 3.78, 95% CI: 1.97-7.27, P<0.0001). Hospital mortality rate, which was analyzed in four trials, including 510 TG versus 729 SG patients, showed no significant difference between the two groups (OR: 1.80, 95% CI: 0.85-3.78, P=0.12). Importantly, there was no significant difference in the 5-year survival between the two groups (OR: 0.68, 95% CI: 0.39-1.19, P=0.18). Mortality rate of recurrence, which was also analyzed in three trials, including 396 TG versus 407 SG patients, showed a significantly higher rate in the TG group (OR: 0.07, 95% CI: 0.01-0.13, P=0.03).

Conclusion: This meta-analysis demonstrated that postoperative complications, hospital mortality rate, and 5-year survival rate in TG patients was similar to the SG group. Furthermore, SG was associated with significantly fewer anastomotic fistula and lower mortality rate of recurrence compared with TG. However, lower mortality rate of recurrence was probably related to the criteria of these two procedures.

Keywords: gastric cancer; randomized controlled trials; subtotal gastrectomy; total gastrectomy.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Meta-analysis of postoperative complications in randomized trials of total gastrectomy versus subtotal gastrectomy. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel.
Figure 2
Figure 2
Meta-analysis of anastomotic fistula in randomized trials of total gastrectomy versus subtotal gastrectomy. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel.
Figure 3
Figure 3
Meta-analysis of hospital mortality rate of total gastrectomy versus subtotal gastrectomy. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel.
Figure 4
Figure 4
Meta-analysis of 5-year survival rate of total gastrectomy versus subtotal gastrectomy. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel.
Figure 5
Figure 5
Meta-analysis of mortality of recurrence in randomized trials of total gastrectomy versus subtotal gastrectomy. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel.
See this image and copyright information in PMC

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