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
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 (PROSP...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
April 2023
|
| In: |
Surgery
Year: 2023, Volume: 173, Issue: 4, Pages: 957-967 |
| ISSN: | 1532-7361 |
| DOI: | 10.1016/j.surg.2022.11.018 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.surg.2022.11.018 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S0039606022009904 
|
| Author Notes: | Julian Hipp, MD, Hans Christian Hillebrecht, MD, Eva Kalkum, Rosa Klotz, MD, Jasmina Kuvendjiska, MD, Verena Martini, MD, Stefan Fichtner-Feigl, MD, Markus K. Diener, MD, MBA |
| Summary: | 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. - Conclusion - Proximal gastrectomy with double-tract reconstruction offers advantages in postoperative nutritional parameters compared to total gastrectomy (GRADE: moderate quality of evidence). Oncological effectiveness of proximal gastrectomy with double-tract reconstruction cannot be assessed (GRADE: very low quality of evidence). Further thoroughly planned randomized controlled trials in Western patient cohorts are necessary to improve treatment for gastric cancer patients. |
|---|---|
| Item Description: | Gesehen am 24.05.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1532-7361 |
| DOI: | 10.1016/j.surg.2022.11.018 |