Distal versus total gastrectomy for middle and lower-third gastric cancer: A systematic review and meta-analysis

Background: The optimal resection extent for middle or lower-third gastric cancer still remains controversial. This study was aim to compare the safety and long-term prognosis of distal gastrectomy (DG) with total gastrectomy (TG) for middle and lower-third gastric cancer. Methods: Pubmed, EMBASE, the Cochrane Library, and Web of Science were searched from inception to October 2017 for comparative studies comparing DG with TG for middle or lower-third gastric cancer. We performed the meta-analysis using RevMan 5.3 software. Results: Overall, 11 comparative studies with 3554 patients, including 4 randomized controlled trials and 7 retrospective cohort studies, were analyzed. Compared with DG, TG showed a higher rate of overall postoperative complication, anastomosis leakage, wound complication, peritoneal abscess, and mortality. There were no significant differences between the two groups in rate of recurrence and cancer-related death. The 5-year overall survival is better in the DG group than in the TG group, but no significant differences were found in stage-specific analysis. Conclusions: Compared with TG, DG is an optimal surgical procedure for middle or lower-third gastric cancer in early and locally advanced stages with better short-term outcomes and comparable long-term prognosis under the precondition of negative proximal resection margin.