Comparative study between total and subtotal gastrectomy for distal gastric cancer: Meta-analysis of prospective and retrospective studies
Cir Esp (Engl Ed). 2020 Dec;98(10):582-590.
doi: 10.1016/j.ciresp.2020.05.028.
Epub 2020 Jun 27.
[Article in
English,
Spanish]
Affiliations
- 1 Servicio de Cirugía General, Departamento de Ciencias Médicas Clínicas (Sección de Cirugía), Hospital Universitario HM Sanchinarro, Universidad San Pablo CEU, Madrid, España; Fundación para el Desarrollo e Investigación de Cirugía Oncológica, Madrid, España. Electronic address: hduran@hmhospitales.com.
- 2 Servicio de Cirugía General, Departamento de Ciencias Médicas Clínicas (Sección de Cirugía), Hospital Universitario HM Sanchinarro, Universidad San Pablo CEU, Madrid, España.
- 3 Departamento de Cuidados Intensivos, Hospital Universitario HM Sanchinarro, Madrid, España.
- 4 Servicio de Cirugía General, Departamento de Ciencias Médicas Clínicas (Sección de Cirugía), Hospital Universitario HM Sanchinarro, Universidad San Pablo CEU, Madrid, España; Fundación para el Desarrollo e Investigación de Cirugía Oncológica, Madrid, España.
- 5 Servicio de Cirugía General, Departamento de Ciencias Médicas Clínicas (Sección de Cirugía), Hospital Universitario HM Sanchinarro, Universidad San Pablo CEU, Madrid, España; Fundación para el Desarrollo e Investigación de Cirugía Oncológica, Madrid, España; Cátedra Internacional de Investigación en Cirugía General y Digestiva, Universidad Católica de Murcia, Murcia, España.
Abstract
There is no clear agreement on the type of gastrectomy to be used (either total [TG] or distal [DG]) in middle or distal gastric cancer, especially when it is undifferentiated or Lauren diffuse type. In this meta-analysis, we intend to define which of the 2techniques should be recommended, based on survival, morbidity and mortality rates. Prospective and retrospective studies comparing both techniques have been included for a total of 6303 patients (3,641 DG and 2,662 TG). DG was significantly associated with fewer complications, fewer anastomotic fistulae, and less perioperative mortality. The number of lymph nodes in DG was significantly lower, but always above 15. Finally, even the 5-year survival of DG was also higher. Therefore, DG, as long as a safety margin is obtained and regardless of the histological type, should be performed in surgery for distal stomach cancer.
Keywords:
Cáncer gástrico; Gastrectomy; Gastrectomía; Gastrectomía subtotal; Gastrectomía total; Gastric cancer; Subtotal gastrectomy; Total gastrectomy.
Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Publication types
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Comparative Study
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Meta-Analysis
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Review
MeSH terms
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Anastomosis, Surgical / adverse effects*
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Female
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Gastrectomy / adverse effects*
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Gastrectomy / methods
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Gastrectomy / mortality*
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Gastric Fistula / epidemiology
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Humans
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Lymph Nodes / pathology
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Lymph Nodes / surgery
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Male
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Margins of Excision
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Perioperative Period / mortality
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Postoperative Complications / epidemiology
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Prospective Studies
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Retrospective Studies
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Stomach Neoplasms / pathology
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Stomach Neoplasms / surgery*
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Survival Rate