Subtotal versus total gastrectomy for remnant gastric cancer: a systematic review and meta-analysis of observational studies

Purpose Subtotal gastrectomy (SG) has become a general option for distal gastric cancer. However, the availability of an organ-preserving approach for the treatment of remnant gastric cancer (RGC) is still controversial. Thus, the objective of the present study was to assess the safety and efficacy of SG for RGC by integrating data from published articles. Methods We searched the PubMed, Cochrane Library, and Web of Science databases for studies that compared SG versus total gastrectomy (TG) for RGC published from the inception of the databases until May 2020. A meta-analysis was performed using the Review Manager Version 5.0 software program from the Cochrane Collaboration. Results Three retrospective cohort studies with 144 patients were included. The meta-analysis revealed that the operative time of the SG group was significantly shorter than that in the TG group (MD: -34.84. 95% CI: -59.97- -9.71, P = 0.007). There was no significant difference in intraoperative blood loss (MD: -109.19. 95% CI: -240.37-21.99, P =0.10), length of postoperative hospital stay (MD: 0.40. 95% CI: -3.03-3.83, P = 0.82), postoperative complications (RR: 1.41. 95% CI: 0.76-2.63, P = 0.28), or recurrence (RR: 2.33, 95% CI: 0.48-11.44, P = 0.30). SG for RGC tended to be correlated with favorable 5-year overall survival; however, the association was not statistically significant (HR: 0.89, 95% CI: 0.63-1.26, P = 0.51). Conclusion Organ-preserving approaches such as SG may be a safe and feasible treatment option for early-stage RGC.

Automated summary

The study aimed to assess the safety and efficacy of subtotal gastrectomy (SG) for remnant gastric cancer (RGC) by integrating data from published articles through a meta-analysis. Results showed that SG had significantly shorter operative time compared to total gastrectomy (TG), with no significant differences in intraoperative blood loss, length of postoperative hospital stay, postoperative complications, or recurrence. Although SG tended to be associated with favorable 5-year overall survival for RGC, the association was not statistically significant.