Comparing survival after proximal gastrectomy vs. total gastrectomy in advanced gastric cancer: A systematic review and meta‑analysis

Abstract

The present systematic review and meta-analysis aimed to compare long-term survival after proximal gastrectomy (PG) and total gastrectomy (TG) for locally advanced proximal gastric cancer (GC). The PubMed, EMBASE and Cochrane CENTRAL databases were searched from their inception to May 2023. Only published two-arm prospective or retrospective studies were included. The selected studies included patients with locally advanced GC who underwent PG or TG and reported quantitative survival outcomes. The primary outcome was overall survival (OS) after gastrectomy. Three studies involving a total of 4,815 patients met the inclusion criteria. The age of the patients ranged from 57.03-64.46 years and 78.80% were male. The estimated 5-year OS probability after TG varied from 30.14 to 72.0%, and from 42.06 to 74.9% after PG. Results of the meta-analyses revealed a significant association between PG and improved OS compared with that of TG, with a pooled hazard ratio of 1.15 (95% CI, 1.05-1.25). No heterogeneity was observed in the included studies (I²=0%). Overall, in managing locally advanced GC, PG demonstrated comparable or marginally improved OS compared with TG during postoperative follow-up; however, further meta-analyses are required to provide stronger evidence.

Keywords: locally advanced gastric cancer; meta-analysis; proximal gastrectomy; survival; systematic review; total gastrectomy.

Figure 1.

Preferred reporting items for systematic reviews and meta-analyses flow diagram of the study selection process. GC, gastric cancer.

Figure 2.

Meta-analysis of overall survival after TG vs. PG for locally advanced gastric cancer. CI, confidence interval; TG, total gastrectomy; PG, proximal gastrectomy.