Systematic review and meta-analysis comparing proximal gastrectomy with double-tract-reconstruction and total gastrectomy in gastric and gastroesophageal junction cancer patients

• Verfasst von: Hipp, Julian [VerfasserIn]
• Verfasst von: Hillebrecht, Hans Christian [VerfasserIn]
• Verfasst von: Kalkum, Eva [VerfasserIn]
• Verfasst von: Klotz, Rosa [VerfasserIn]
• Verfasst von: Kuvendjiska, Jasmina [VerfasserIn]
• Verfasst von: Martini, Verena [VerfasserIn]
• Verfasst von: Fichtner-Feigl, Stefan [VerfasserIn]
• Verfasst von: Diener, Markus K. [VerfasserIn]
• Titel: Systematic review and meta-analysis comparing proximal gastrectomy with double-tract-reconstruction and total gastrectomy in gastric and gastroesophageal junction cancer patients
• Titelzusatz: still no sufficient evidence for clinical decision-making
• Verf.angabe: 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
• E-Jahr: 2023
• Jahr: April 2023
• Umfang: 11 S.
• Fussnoten: Gesehen am 24.05.2023
• Titel Quelle: Enthalten in: Surgery
• Ort Quelle: Amsterdam [u.a.] : Elsevier, 1995
• Jahr Quelle: 2023
• Band/Heft Quelle: 173(2023), 4 vom: Apr., Seite 957-967
• ISSN Quelle: 1532-7361
• DOI: doi:10.1016/j.surg.2022.11.018
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1846079713

Abstract

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.