Systematic Review and Meta-analysis Comparing Proximal Gastrectomy with Double-tract-reconstruction and Total Gastrectomy in Gastric and Gastroesophageal Junction Cancer Patients: Still No Sufficient Evidence for Clinical Decision-making
Systematic Review and Meta-analysis Comparing Proximal Gastrectomy with Double-tract-reconstruction and Total Gastrectomy in Gastric and Gastroesophageal Junction Cancer Patients: Still No Sufficient Evidence for Clinical Decision-making

Author: Julian Hipp

Publisher:

Published: 2023

Total Pages: 0

ISBN-13:

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Abstract: Background To compare proximal gastrectomy with double-tract reconstruction and total gastrectomy in patients with gastroesophageal junction (AEG II-III) and gastric cancer. Methods We conducted systematic searches in Medline, Web of Science, and Cochrane Library until December 20, 2021 (PROSPERO registration number: CRD42021291500). Risk of bias was assessed using the revised Cochrane risk of bias tool and the ROBINS-I tool, as applicable. Evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results One randomized controlled trial (RCT) and 13 non-RCTs with 1,317 patients (715 patients with total gastrectomy and 602 patients with proximal gastrectomy with double-tract reconstruction) were included. Patients treated by total gastrectomy had a significantly higher proportion of advanced cancer stages International Union Against Cancer IB-III (odds ratio: 0.68, 95% confidence interval: 0.51-0.91, P = .01). This heterogeneity biases the observed improved overall survival of patients after proximal gastrectomy with double-tract reconstruction (odds ratio: 0.67, 95% confidence interval: 0.44-1.01, P = .05). Both procedures were comparably efficient regarding perioperative parameters. Postoperative/preoperative bodyweight ratio (mean difference: 3.56, 95% confidence interval: 1.32-5.79, P = .002), postoperative/preoperative serum-hemoglobin ratio (mean difference 3.73, 95% confidence interval: 1.59-5.88, P .001), and postoperative serum vitamin B12 levels (mean difference 42.46, 95% confidence interval: 6.37-78.55, P = .02) were superior after proximal gastrectomy with double-tract reconstruction, while postoperative/preoperative serum-albumin ratio (mean difference 1.24, 95% confidence interval: -4.76 to 7.24, P = .69) and postoperative/preoperative serum total protein ratio (mean difference 1.12, 95% confidence interval: -2.77 to 5.00, P = .57) were not different. Health-related quality of life data were reported in only 2 studies, which found no significant advantages for proximal gastrectomy with double-tract reconstruction.brbrConclusion

Total, Subtotal and Proximal Gastrectomy in Cancer
Total, Subtotal and Proximal Gastrectomy in Cancer

Author: Walter Siquini

Publisher: Springer

Published: 2015-05-05

Total Pages: 222

ISBN-13: 8847057493

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This richly illustrated volume describes the performance of total and subtotal gastrectomy with extended D2 lymphadenectomy by providing a detailed step-by-step guide to both manual and mechanical procedures. Gastric cancer is the fourth most commonly occurring cancer and the second most common cancer-related cause of death worldwide, and surgery remains the only potentially curative treatment. Although several aspects of surgical management are still controversial, all guidelines for the treatment of curable gastric cancer recommend subtotal gastrectomy (for tumors located in the antrum and corpus) or total gastrectomy (for tumors located in the fundus) with extended D2 lymphadenectomy. Various technical tips and secrets are revealed that serve to simplify the procedure and simultaneously make it more effective: by rendering esophagojejunal and gastrojejunal anastomosis more secure, the risk of leakage is minimized. High-quality intraoperative color photographs and drawings covering all steps facilitate understanding of these complex operations and will prove an invaluable tool for surgeons, residents and professionals in the field.