Surgical Outcomes of Gastric Remnant Cancer in Comparison with Primary Gastric Cancer: a Systematic Review and Meta-Analysis

Abstract

The purpose of this study was to compare outcomes following resection of gastric remnant cancer (GRC) and primary gastric cancer (PGC). The publicly available literature published from January 1990 to November 2019 concerning GRC and PGC after radical resection was retrieved by searching the national and international online databases. Meta-analysis was performed after the data extraction process. Our studies showed that the overall complication rates following GRC resection were 45.3% and 39.7% in PGC, and this difference was statistically significant(OR 1.90, 95% CI 1.19–3.03; p = 0.007). Moreover, we found PGC group had fewer surgical complications (20.5% in GRC and 17.9% in PGC), and this difference was statistically significant (OR 1.75, 95% CI 1.05–2.92; p = 0.03). The overall 5-year survival rate was 42.1% for patients with GRC, and 48.9% for PGC patients. It seemed that the 5-year survival rate was slightly better for the PGC group compared with the GRC group (OR 1.18, 95% CI 0.86–1.62; p = 0.31), but no significant difference was found between the two groups. In the stage I or II subgroup, the 5-year survival was not significantly different between GRC and PGC (OR 0.48, 95% CI 0.12–1.90; p = 0.29). On the contrary, there was a statistically significant difference in the 5-year survival between GRC and PGC in the stage III or IV subgroup (OR 2.16; 95% CI 1.31–3.57; p = 0.003), without statistical heterogeneity among the studies (I2 = 0%; p for heterogeneity = 0.45). Although the total complications after radical resection in patients with GRC were higher than in those with PGC, the 5-year survival rates were similar in patients in the stage I or II subgroup. However, stage III and IV gastric remnant tumors have much poor prognosis than PGC. Therefore, early detection is an important way to improve overall survival in GRC.