A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

Li, Shengnan; Gu, Liang; Shen, Zefeng; Mao, Danyi; Khadaroo, Parikshit Asutosh; Su, Hui

doi:10.21203/rs.2.11186/v2

Cited by 13 publications

(15 citation statements)

References 17 publications

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“…We did not investigate PG with EJ stomy because a number of studies showed that PG with EG stomy was associated with a higher incidence of complications such as reflux, stenosis, and stricture than TG [ 15 , 23 , 39 ]. Furthermore, several studies reported that there was no significant difference in surgical outcomes between LPG with DTR and LTG [ 3 , 24 , 25 , 27 , 40 – 42 ]. In a previous study, LPG with DTR did not increase the incidences of reflux esophagitis and anastomotic stenosis compared to LTG.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, the incidence of reflux symptoms, usage of proton pump inhibitors, and anastomotic strictures were significantly lower in the DTR than in the EG stomy group [23]. Li et al performed a meta-analysis to compare the use of LPG-DTR and TG for proximal early gastric cancer [25]. They concluded that PG-DTR is comparable to TG for patients with proximal early gastric cancer, and reported that LPG-DT not only appears superior to TG in terms of preventing vitamin B 12 deficiency, but also does not increase the risks of anastomotic stricture and reflux esophagitis.…”

Section: Introductionmentioning

confidence: 99%

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Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases.

Choi¹,

Choi²,

Ko³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: Proximal gastrectomy is an alternative treatment modality for gastric cancer in the upper third of the stomach. Though several reconstruction methods have been introduced, there is no standardization. We investigated the outcomes of laparoscopic proximal gastrectomy with double tract reconstruction (LPG-DTR). Aim: To investigate the outcomes of LPG-DTR. Material and methods: We evaluated 37 patients who underwent curative LPG with DTR between December 2013 and December 2018. Less than half of the proximal stomach was laparoscopically resected. We performed LPG-DTR after resection. Results: A total of 37 patients were included in this study, 25 (70%) of whom were male and 12 (30%) of whom were female. Overall, 31 (83.7%) patients were diagnosed with gastric cancer, 5 (13.5%) with gastrointestinal stromal tumors, and 1 (2.8%) with leiomyoma. There were 3 (9.6%) complications. However, there were no complications of grade 3 or above. We did not observe postoperative mortality or recurrence after surgery. All patients underwent postoperative endoscopic surveillance successfully. None of the patients had postoperative reflux esophagitis or stenosis. The body weight and hemoglobin levels of the patients were lowest 12 months after surgery and gradually increased thereafter. Similarly, their vitamin B 12 levels were lowest 6 months after surgery. However, iron been increased after surgery until 24 months after surgery. Conclusions: LPG-DTR is a favorable treatment modality for gastric cancer in the upper third of the stomach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases.

Choi¹,

Choi²,

Ko³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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“…The esophagojejunostomy techniques, such as that done with jejunal interposition (JI) or DTR, are now thought to be alternatives to esophagogastrostomy (EG) reconstruction after PG to prevent postoperative complications [7, 51, 52]. For example, Li et al [53] showed that there was no difference statistically in anastomotic stenosis and reflux esophagitis between laparoscopy-assisted proximal gastrectomy (LAPG) with DTR and laparoscopy-assisted total gastrectomy (LATG), which showed an optimistic prospect for PG feasibly.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

et al. 2020

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Introduction: The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis. Methods: We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes. Results: A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08–4.50]; p = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85–5.99]; p < 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = −10.46 [95% CI: −12.76 to −8.17]; p < 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03–1.77]; p = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59–2.45]; p = 0.62). Conclusion: In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.

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“…Hence, the risk of leakage is increased. However, a latest meta-analysis consisted of 592 patients found that laparoscopic proximal gastrectomy with double-tract reconstruction (PG-DTR) had comparable short-term outcome with laparoscopic total gastrectomy (TG) [26]. As a novel reconstruction procedure considered superior to TG in term of nutrition, the clinical outcomes of PG-DTR were still controversial.…”

Section: Discussionmentioning

confidence: 99%

The variation tendency of serum C-reactive protein is a good marker to predict postoperative complications after laparoscopic gastrectomy for adenocarcinoma of esophagogastric junction

Luo¹,

Liao²,

Zheng³

et al. 2020

Preprint

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Background: Postoperative complications (PCs) after laparoscopic gastrectomy with mediastinal lymph nodes resection for adenocarcinoma of esophagogastric junction (AEG) prolonged the time of hospitalization and increased mortality rate. Early diagnosis of PCs was of great importance. This retrospective study aimed to investigate whether the variation tendency of serum C-reactive protein can be used as an early marker to predict major postoperative complications after laparoscopic gastrectomy for AEG.Methods: Data for patients underwent laparoscopic gastrectomy for AEG, from January 2015 to March 2020, were retrospectively analyzed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine diagnostic accuracy of inflammatory markers. The optimal cutoff values were calculated by maximizing Youden’s index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PCs of grade III or more，according to the Clavien-Dindo classification. Results: A total of 114 patients were analyzed, of whom 21 (18.4%, 95% CI 11.4-25.4 %) developed major PCs, including anastomotic leakage in 13. The ratio of CRP level on postoperative day 3 to day 2 (POD3/2 CRP) provided the best diagnostic accuracy (AUC 0.903, 95% CI 0.814-0.993, p＜0.001). Proximal gastrectomy (OR 8.224, 95% CI 1.976-34.234, p=0.004) and operation time ≥360 minutes (OR 6.753, 95% CI 2.037-22.395, p=0.002) were identified as significant independent risk factors for major PCs.Conclusions: The POD3/2 CRP was the best marker to predict PCs after laparoscopic gastrectomy for AEG.

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A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

Cited by 13 publications

References 17 publications

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases.

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases.

Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

The variation tendency of serum C-reactive protein is a good marker to predict postoperative complications after laparoscopic gastrectomy for adenocarcinoma of esophagogastric junction

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