Adenocarcinoma of the gastric antrum: does D2 total gastrectomy with splenectomy improve prognosis compared to D1 subtotal gastrectomy? A long-term survival analysis with emphasis on Lauren classification

Roukos, Dimitrios H; Schmidt-Mathiesen, A.; Encke, A.

doi:10.1016/s0960-7404(10)80045-3

Cited by 18 publications

(7 citation statements)

References 21 publications

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“…The strong correlation between tumor location and nodepositive hilar cases explains why survival was not significantly different for patients with antral carcinoma: they underwent either a combined total gastrectomy plus splenectomy or a simple subtotal gastrectomy. 30,31 The adverse effect of splenectomy on postoperative morbidity and mortality has been shown in retrospective series 29,[32][33][34][35] and was confirmed recently in two large European randomized trials that compared D1 with D2 gastrectomy. 36,37 However, the impact of splenectomy, from the immunological aspect, on long-term survival is unknown.…”

Section: Spleen Preservation Versus Splenectomymentioning

confidence: 91%

Current Advances and Changes in Treatment Strategy May Improve Survival and Quality of Life in Patients With Potentially Curable Gastric Cancer

Roukos

1999

Ann Surg Oncol

107

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Section: Spleen Preservation Versus Splenectomymentioning

confidence: 91%

Current Advances and Changes in Treatment Strategy May Improve Survival and Quality of Life in Patients With Potentially Curable Gastric Cancer

Roukos

1999

Ann Surg Oncol

107

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“…Surgical resection is the only therapy and an option to enhance the survival rate of patients with gastric cancer[2]. The extent of gastrectomy for curative treatment of gastric cancer depends on tumor location, tumor size and tumor stage[3,4]. However, the distal subtotal gastrectomy and total gastrectomy for centuries, there has been controversy about the choice of the best surgical procedure for the distal half of gastric cancer which is usually resection by the distal subtotal gastrectomy in china[5].…”

Section: Introductionmentioning

confidence: 99%

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

Zhang²,

Wang

et al. 2016

PLoS ONE

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Background/AimsTotal 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.MethodologyA search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed. Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis. Review Manager 5.2 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 12.0 software for meta-regression analysis.ResultsTen retrospective cohort studies and one randomized control trial involving 5447 patients were included. The meta-analysis showed no significant difference of postoperative mortality (RR = 1.48, 95%CI = 0. 90–2.44,p = 0.12), intraoperative blood loss (MD = 24.34, 95%CI = -3.31–51.99, p = 0.08) and length of hospital stay(MD = 0.76, 95%CI:-0.26–1.79, p = 0.15). TG procedure could retrieve more lymph nodes than DG(MD = 4.33, 95% CI = 2.34–6.31, p<0.0001). According to different postoperative complications, we performed subgroup analysis, subgroup analysis revealed that patients in TG group tended to have a higher rate of postoperative intra-abdominal abscess than DG procedure (RR = 3.41, 95% CI = 1.21–9.63,p<0.05). No statistical differences were found in leakage, intestinal obstruction, postoperative bleeding, anastomotic stricture and wound infection between the two groups (p>0.05). We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 49.6% (919/1852) vs.55.9%(721/1290) respectively. Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 0.91,95% CI = 0.85–0.97,p = 0.006).ConclusionBased on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate. DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed.

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“…Additionally, some studies demonstrated that TG was preferable to SG, because patients treated with TG had longer 5-year survival than patients treated with SG 8–10. On the other hand, advocates of SG claimed that routine use of TG increased operative morbidity and hospital mortality, and had no advantage over SG in terms of 5-year oncological results 11–13…”

Section: Introductionmentioning

confidence: 99%

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

Kong¹,

Yang²,

Shi³

et al. 2016

OTT

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ObjectivesThis 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.MethodsThe 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.ResultsSix 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).ConclusionThis 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.

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Adenocarcinoma of the gastric antrum: does D2 total gastrectomy with splenectomy improve prognosis compared to D1 subtotal gastrectomy? A long-term survival analysis with emphasis on Lauren classification

Cited by 18 publications

References 21 publications

Current Advances and Changes in Treatment Strategy May Improve Survival and Quality of Life in Patients With Potentially Curable Gastric Cancer

Current Advances and Changes in Treatment Strategy May Improve Survival and Quality of Life in Patients With Potentially Curable Gastric Cancer

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis

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

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