Abstract
BackgroundDue to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG). However, controversies still persist regarding the surgical efficacy and oncological safety of PPG.MethodsOriginal studies comparing PPG and DG for EGC were searched in PubMed, Embase, and the Cochrane Register of Controlled Trials up to December 2019. The weight mean difference, standardized mean difference, or odds risk was used to calculate the short-term and long-term outcomes between the two groups.ResultsTwenty-one comparative studies comprising 4871 patients (1955 in the PPG group and 2916 in the DG group) were enrolled in this systematic review and meta-analysis. PPG showed longer hospital day, decreased harvested lymph nodes, and more delayed gastric emptying. However, PPG had the benefits of lower incidence of anastomosis leakage, early dumping syndrome, gastritis and bile reflux, and better recovery of total protein, albumin, hemoglobin, and weight. No difference was found in operative time, blood loss, and overall complications. Moreover, the long-term survival and recurrence rate were similar in two groups.ConclusionOwing to the non-inferiority of surgery and oncology outcomes and the superiority of function outcomes in PPG, we revealed that PPG can be clinically applicable instead of DG in EGC. However, more high-quality comparative studies and randomized clinical trials would be required for further confirmation.
Highlights
Due to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG)
Many studies comparing PPG and DG in terms of surgical and functional outcomes have been published [7,8,9], whether PPG is better than DG for EGC without compromising oncological safety remains debatable because of lacking long-term oncologic outcomes and high-level evidence of randomized clinical trials (RCTs)
When the reports included in our work only report mean and range, standard deviation (SD) was estimated based on the formulas reported by Hozo et al [14]
Summary
Due to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG). Many studies comparing PPG and DG in terms of surgical and functional outcomes have been published [7,8,9], whether PPG is better than DG for EGC without compromising oncological safety remains debatable because of lacking long-term oncologic outcomes and high-level evidence of randomized clinical trials (RCTs). The first meta-analysis, which was published in 2014 [10], demonstrated that PPG had superior benefits in terms of lower incidence rates of early dumping syndrome, gastritis, and bile reflux as well as regaining of weight. We performed an updated meta-analysis to demonstrate the surgery efficacy, oncologic safety, and function recovery of PPG
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