The Efficacy Of Proximal Gastrectomy And Total Gastrectomy For Proximal Early Gastric Cancer In East Asia: A Meta-analysis

Objective:By means of meta-analysis,this paper discussed the efficacy of proximal gastrectomy and total gastrectomy in the treatment of early proximal gastric cancer patients in east Asia.Methods:The literatures about proximal gastrectomy and total gastrectomy for early proximal gastric cancer were searched from PubMed,Embase,the Cochrane Library,CBM,CNKI,WANFANG databases.Intraoperative blood loss,operative time,postoperative length of stay,postoperative complication rate,5-year survival rate,tumor recurrence rate,and postoperative nutritional status were evaluated in the two groups,and Meta analysis was performed by using RevMan 5.3.Results:In this study,a total of 23 articles were collected,all of which were retrospective studies,and 2997 patients were included,including 1237 patients in the PG group and 1760 patients in the TG group.There was no significant differences in operative time(WMD=-5.37,95%ci =-30.88-20.14,P=0.68),intraoperative blood loss(WMD=-26.11,95%ci =-61.16-8.94,P= 0.14),total incidence of postoperative complications(OR=1.16,95%ci =0.63-2.16,P=0.64),anastomotic fistula OR=0.61,95%ci = 0.34-1.11,P= 0.11),abdominal infection(OR=0.65,95%ci = 0.31-1.36,P=0.25),5-year postoperative survival rate(OR=1.20,95CI= 0.78-1.85,P=0.40),tumor recurrence rate(OR=1.98,95CI= 0.71-5.49,P=0.19).While there were significant differences in postoperative length of stay(WMD=0.68,95CI= 0.18-1.18,P=0.008),anastomotic stenosis(OR=1.73,95CI= 1.18-2.52,P=0.005),reflux esophagitis(OR=2.59,95%ci =1.06 ~ 6.31,P=0.04),intestinal obstruction(OR=0.30,95%ci =0.16 ~ 0.56,P=0.0002),the ratio of body weight,hemoglobin,albumin and total protein to that before surgery(WMD=4.38,95%ci = 2.70-6.06,P < 0.05).WMD=4.15,95%ci =3.10 ~ 5.21,P < 0.05.WMD=2.53,95%ci =1.45 ~ 3.60,P < 0.05.WMD=2.36,95%ci =0.16 ~ 4.56,P=0.04).The PG group was superior to the TG group in postoperative nutritional status and postoperative intestinal obstruction,and the TG group was superior to the PG group in postoperative anastomotic stenosis and reflux esophagitis.Conclusion:For the treatment of patients with proximal early gastric cancer in East Asia,proximal gastrectomy and total gastrectomy have the same long-term efficacy.The nutritional status of patients after proximal gastrectomy is better than that after total gastrectomy.The complication rate of reflux esophagitis and anastomotic stenosis after proximal gastrectomy is higher than that after total gastrectomy.