Meta-analysis Of Total Versus Proximal Gastrectomy For Proximal Gastric Cancer

Objective：To assess the value of proximal gastrectomy(PG) and totalgastrectomy(TG) for the treatment of proximal gastric cancer.Methods：Studies comparing TG to PG for proximal gastric cancer.Outcome measures included harvested LNs、blood loss、operation time、postoperative complication、 mortality、5-year overall survival rate、recurrence rate as well as nutritional states.Meta-analysis were performed byRevMan5.0.Results：Twenty five reseaches were included in these studies.Three ofwhice were randomly controlled studies.There were no significantdifferences in the postoperative complication（OR=1.93，95%CI=0.97～3.85，P=0.06）、anastomotic leak（OR=0.74，95%CI=0.31～1.76，P=0.49）、intestinal obstruction（OR=0.45，95%CI=0.13～1.50，P=0.19）、refluxesophagitis（OR=4.82，95%CI=0.94～24.62，P=0.06）、recurrence rate（OR=2.45，95%CI=0.96～6.25，P=0.06）、5-year overall survival rate（OR=1.03，95%CI=0.55～1.93，P=0.93）、mortality（OR=1.05，95%CI=0.70～2.50，P=0.04）.While there were significant differences in theharvested LNs（WMD=-11.14，95%CI=-17.81～-4.48，P=0.001）、bloodloss（WMD=-425.60，95%CI=-559.75～-291.46，P＜0.00001）、operation time（WMD=-37.24，95%CI=-62.76～-11.72，P=0.004）、anastomoticstenosis（OR=2.65，95%CI=1.11～6.33，P=0.03）. harvested LNs andanastomotic stenosis in the TG group were better than that in the PG group,blood loss and operation time in the PG group were better than that in the TGgroup.Conclusion：Total gastrectomy for proximal gastric cancer has betterlong-term therapetic effect.