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

Objective : For the treatment of proximal gastric cancer,we discussed the value of proximal gastrectomy and total gastrectomy in the treatment of proximal gastric cancer,and we hope to provide some reference for the choice of surgical methods in clinical.Methods:We searched PubMed?Medline?The Cochrane Library ? China National Knowledge database and Wanfang Database to search relevant literature about proximal gastrectomy and total gastrectomy for proximal gastric cancer for 25 years.With screening accordance strictly to the standard,assessing the quality of these studies,data were extracted from these trials and analyzed by the Review Manager 5.3 software.Results:A total of 13 studies(2 Chinese Literature,11 Foreign literature)were included in the study,2 of whice were randomly controlled studies and the rest were high quality clinical experiment,and 6649 patients were include,PGs have 1132 patients,and TGs have 5517 patients.The Meta analysis results showed that: compared with the total gastrectomy,proximal gastrectomy for proximal cardiac cancer in operation time [WMD=-39.42,95 % CI(-76.37,-2.47),P=0.04] ? in the blood lose[WMD=-237.86,95%CI(-435.63,-40.08),p=0.02]?the number of dissected lymph nodes [WMD=-12,95%CI(-18.98,-5.02),P=0.0008]?reflux esophagitis [OR=17.68,95%CI=7.97-39.21,P < 0.00001],P=0.07 ] the differences were statistically significant.No significant difference in anastomotic leak[OR=0.68,95%CI=0.34-1.38,P=0.29]?intestinal obstruction[OR=0.7,95%CI=0.30-1.63,P=0.41 ]?total postoperativecomplication [OR=2.00,95%CI=0.84-4.79,P=0.12 ]?survival rate at 1 years[OR=1.64,95%CI=0.97-2.75,P=0.06 ]?survival rate at 3 years[OR=1.17,95%CI=0.71-1.93,P=0.55]?survival rate at 5 years [OR=0.90,95%CI=0.70-1.15,P=0.38]?during postoperative half year [WMD=-0.01,95%CI(-0.10,0.08),P=0.81]and 1 year total protein[WMD=0.01,95%CI(-0.11,0.12),P=0.92.Conclusion:Proximal gastrectomy and total gastrectomy for stage I and II proximal gastric cancer have less operative wound and no significant difference in postoperative complications,nutritional status and survival rate.