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

Abstract 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.