Distal versus total gastrectomy for middle and lower-third gastric cancer: A systematic review and meta-analysis

Li, Zhengyan; Bai, Bin; Xie, Fengni; Zhao, Qingchuan

doi:10.1016/j.ijsu.2018.03.047

Cited by 42 publications

(29 citation statements)

References 52 publications

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“…The results of our study suggest that SG for GSC located at the anastomotic site is associated with the same long-term outcomes as the traditional TG procedure, indicating that SG is feasible and safe from an oncological perspective. Previous studies have reported that compared with TG, SG is associated with better short-term outcomes and similar long-term results in middle-third gastric cancer [23,24]. Moreover, compared with SG patients, TG patients are expected to encounter more serious consequences, such as lifelong vitamin B12 supplementation, more symptoms caused by food intolerance, and more alterations in dietary habits because of having a smaller food reservoir [25,26].…”

Section: Discussionmentioning

confidence: 99%

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

Yang

et al. 2020

World J Surg Onc

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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 underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared. Results: The operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046). Conclusions: The results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.

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Section: Discussionmentioning

confidence: 99%

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

Yang

et al. 2020

World J Surg Onc

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“…Together with tumor-related outcomes, two other important aspects should be considered when planning a gastrectomy for GAC: postoperative morbidity and quality of life. Morbidity has been shown to be related to the resection extent, with TG yielding a higher rate of postoperative complications than DG, [37][38][39][40] especially when associated with esophagectomy. 17 Total gastrectomy has also been associated with worsened quality of life 3,4,[41][42][43] and higher rate of dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series

et al. 2022

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Purpose No consensus exists on the resection extent needed to ensure oncological safety in gastrectomy for gastric adenocarcinoma (GAC). This study aims to assess the impact of margin adequacy according to Japanese Gastric Cancer Association (JGCA) guidelines on overall survival (OS). Patients and Methods Patients who underwent surgery for stage I–III GAC at our institution between 2010 and 2017 were included. Margin adequacy according to JGCA, National Comprehensive Cancer Network (NCCN), and European Society for Medical Oncology (ESMO) guidelines was assessed, and their predictive value on OS was evaluated with Harrell’s C-index. Patients were analyzed according to their margins’ adherence to JGCA guidelines, and a propensity score matching (PSM) was run. Indication to either total gastrectomy (TG) or distal gastrectomy (DG) according to each guideline was also assessed. Results A total of 279 patients were included, of whom 220 (79%) underwent DG. Adequate margins according to JGCA were obtained in 209 patients (75%). On multivariate analysis, JGCA margin adequacy was independently associated with OS, together with American Society of Anesthesiologist class, neoadjuvant chemotherapy, lymphadenectomy extent, R0 resection, and postoperative N stage. After PSM, patients with JGCA adequate margins showed better OS, recurrence-free survival (RFS), and local RFS than patients with JGCA inadequate margins. For 220 DG, JGCA guidelines would have recommended TG in 25 patients (11%), NCCN in 30 (14%), and ESMO in 90 (41%) (p < 0.001). Conclusion Adequacy of surgical resection margins to JGCA guidelines leads to improved survival outcomes and allows for a more organ-preserving approach than Western guidelines.

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“…Regarding the surgical approach, one study revealed that distal gastrectomy had comparable long-term survival to total gastrectomy for middle and lower third GC when R0 resection was achieved [27]. Apart from conventional open surgery, laparoscopic gastrectomy has also been performed in recent years [28].…”

Section: Discussionmentioning

confidence: 99%

A novel nomogram based on cardia and chemotherapy to predict postoperative overall survival of gastric cancer patients

Jiang

2021

Preprint

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Background: We aimed to establish and externally validate a nomogram to predict the 3- and 5-year overall survival (OS) of gastric cancer (GC) patients after surgical resection and explored the roles of cardia and chemotherapy.Methods: A total of 6543 patients diagnosed with primary GC during 2004-2016 were collected from the Surveillance, Epidemiology and End Results (SEER) database. We grouped patients diagnosed during 2004-2012 into a training set (n=4528) and those diagnosed during 2013-2016 into an external validation set (n=2015). A nomogram was constructed after univariate and multivariate analysis. Performance was evaluated by Harrell’s C-index, area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and calibration plot.Results: The multivariate analysis identified age, race, location, tumor size, T stage, N stage, M stage, and chemotherapy as independent prognostic factors. In multivariate analysis, the hazard ratio (HR) of non-cardia was 0.762 (P<0.001), and that of chemotherapy was 0.556 (P<0.001). Our nomogram was found to exhibit excellent discrimination: in the training set, Harrell’s C-index was superior to that of the 8th American Joint Committee on Cancer (AJCC) TNM classification (0.736 vs 0.699, P<0.001); the C-index was also better in the validation set (0.748 vs 0.707, P<0.001). The AUCs for 3- and 5-year OS were 0.806 and 0.815 in the training set and 0.775 and 0.783 in the validation set, respectively. The DCA and calibration plot of the model also shows good performance.Conclusions: We established a well-designed nomogram to accurately predict the OS of primary GC patients after surgical resection. We also further confirmed the prognostic value of cardia and chemotherapy in predicting the survival rate of GC patients.

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Distal versus total gastrectomy for middle and lower-third gastric cancer: A systematic review and meta-analysis

Abstract: Compared with TG, DG is an optimal surgical procedure for middle or lower-third gastric cancer in early and locally advanced stages with better short-term outcomes and comparable long-term prognosis under the precondition of negative proximal resection margin.

Cited by 42 publications

References 52 publications

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series

A novel nomogram based on cardia and chemotherapy to predict postoperative overall survival of gastric cancer patients

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