Abstract
Although proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform PG due to the high rate of postoperative reflux. This meta-analysis aimed to comprehensively compare operative outcomes, nutritional outcomes, and quality of life-related complications between TG and PG performed with esophagogastrostomy (EG), jejunal interposition, or double-tract reconstruction (DTR) to reduce reflux after PG. After searching PubMed, Embase, Medline, and Web of Science databases, 25 studies comparing PG with TG in upper-third EGC published up to October 2020 were identified. PG with DTR was similar to TG regarding operative outcomes. Patients who underwent PG with DTR had less weight reduction (weighted mean difference [WMD] 4.29; 95% confidence interval [0.51–8.07]), reduced hemoglobin loss (WMD 5.74; [2.56–8.93]), and reduced vitamin B12 supplementation requirement (odds ratio [OR] 0.06; [0.00–0.89]) compared to patients who underwent TG. PG with EG caused more reflux (OR 5.18; [2.03–13.24]) and anastomotic stenosis (OR 3.94; [2.40–6.46]) than TG. However, PG with DTR was similar to TG regarding quality of life-related complications including reflux, anastomotic stenosis, and leakage. Hence, PG with DTR can be recommended for patients with upper-third EGC considering its superior postoperative nutritional outcomes.
Highlights
Proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform proximal gastrectomy (PG) due to the high rate of postoperative reflux
In Korea, which has the highest incidence of gastric cancer worldwide, PG accounted for only 1.1% of all gastric cancer surgeries, while upper-third gastric cancer accounted for 16.0% of all gastric cancer cases in 2 0141
TG is known to cause nutritional disadvantages compared to PG, especially in vitamin B12 because of the decrease in the intrinsic factor secreted by parietal cells located in the distal s tomach[8]
Summary
Proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform PG due to the high rate of postoperative reflux. This meta-analysis aimed to comprehensively compare operative outcomes, nutritional outcomes, and quality of life-related complications between TG and PG performed with esophagogastrostomy (EG), jejunal interposition, or double-tract reconstruction (DTR) to reduce reflux after PG. PG with DTR can be recommended for patients with upper-third EGC considering its superior postoperative nutritional outcomes. Despite the advantages in preserving the distal stomach, surgeons are reluctant to perform PG with esophagogastrostomy (EG) because of the notorious gastroesophageal reflux that occurs after PG10. To help surgeons decide regarding optimal anastomosis for patients with EGC undergoing PG, a comprehensive analysis of PG with several anastomotic methods is needed
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