Skip to main content
SpringerLink
Log in

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

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Balfour DC (1922) Factors influencing the life expectancy of patients operated on for gastric ulcer. Ann Surg 76(3):405–408

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kwon IG, Cho I, Guner A, Choi YY, Shin HB, Kim HI, An JY, Cheong JH, Noh SH, Hyung WJ (2014) Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surg Endosc 28(8):2452–2458. https://doi.org/10.1007/s00464-014-3496-8

    Article  PubMed  Google Scholar 

  3. Son SY, Lee CM, Jung DH, Lee JH, Ahn SH, Park DJ, Kim HH (2015) Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience. Gastric Cancer : Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc 18(1):177–182. https://doi.org/10.1007/s10120-014-0339-1

    Article  Google Scholar 

  4. Tanigawa N, Nomura E, Lee SW, Kaminishi M, Sugiyama M, Aikou T, Kitajima M (2010) Current state of gastric stump carcinoma in Japan: based on the results of a nationwide survey. World J Surg 34(7):1540–1547. https://doi.org/10.1007/s00268-010-0505-5

    Article  PubMed  PubMed Central  Google Scholar 

  5. Qi J, Zhang P, Wang Y, Chen H, Li Y (2016) Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis. PLoS One 11(10):e0165179. https://doi.org/10.1371/journal.pone.0165179

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Takahashi M, Terashima M, Kawahira H, Nagai E, Uenosono Y, Kinami S, Nagata Y, Yoshida M, Aoyagi K, Kodera Y, Nakada K (2017) Quality of life after total vs distal gastrectomy with Roux-en-Y reconstruction: Use of the Postgastrectomy Syndrome Assessment Scale-45. World J Gastroenterol 23(11):2068–2076. https://doi.org/10.3748/wjg.v23.i11.2068

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hosokawa Y, Konishi M, Sahara Y, Kinoshita T, Takahashi S, Gotohda N, Kato Y, Kinoshita T (2014) Limited subtotal gastrectomy for early remnant gastric cancer. Gastric Cancer : Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc 17(2):332–336. https://doi.org/10.1007/s10120-013-0280-8

    Article  Google Scholar 

  8. Irino T, Hiki N, Nunobe S, Ohashi M, Tanimura S, Sano T, Yamaguchi T (2014) Subtotal gastrectomy with limited lymph node dissection is a feasible treatment option for patients with early gastric stump cancer. J Gastrointest Surg : Off J Soc Surg Aliment Tract 18(8):1429–1433. https://doi.org/10.1007/s11605-014-2576-3

    Article  Google Scholar 

  9. Goto H, Kanaji S, Otsubo D, Oshikiri T, Yamamoto M, Nakamura T, Suzuki S, Fujino Y, Tominaga M, Kakeji Y (2019) Comparison of total versus subtotal gastrectomy for remnant gastric cancer. Langenbeck's Arch Surg 404(6):753–760. https://doi.org/10.1007/s00423-019-01821-x

    Article  Google Scholar 

  10. Ma F, Li Y, Li W, Kang W, Liu H, Ma S, Wang B, Xie Y, Zhong Y, Chen Y, Xue L, Tian Y (2020) Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions? World J Surg Oncol 18(1):43. https://doi.org/10.1186/s12957-020-01821-y

    Article  PubMed  PubMed Central  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  13. Sinning C, Schaefer N, Standop J, Hirner A, Wolff M (2007) Gastric stump carcinoma - epidemiology and current concepts in pathogenesis and treatment. Eur J Surg Oncol : J Eur Soc Surg Oncol Br AssocSurg Oncol 33(2):133–139. https://doi.org/10.1016/j.ejso.2006.09.006

    Article  CAS  Google Scholar 

  14. Mezhir JJ, Gonen M, Ammori JB, Strong VE, Brennan MF, Coit DG (2011) Treatment and outcome of patients with gastric remnant cancer after resection for peptic ulcer disease. Ann Surg Oncol 18(3):670–676. https://doi.org/10.1245/s10434-010-1425-1

    Article  PubMed  Google Scholar 

  15. Wang H, Qi H, Liu X, Gao Z, Hidasa I, Aikebaier A, Li K (2021) Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection. Sci Rep 11(1):2022. https://doi.org/10.1038/s41598-021-81663-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kung CY, Fang WL, Wang RF, Liu CA, Li AFY, Wu CW, Shyr YM, Chou SC, Huang KH (2020) Prognosis and clinicopathologic features in patients with gastric stump cancer after curative surgery. Curr Oncol (Toronto, Ont) 27(3):e259–e264. https://doi.org/10.3747/co.27.6017

    Article  CAS  Google Scholar 

  17. Otsuka R, Hayashi H, Sakata H, Uesato M, Hayano K, Murakami K, Kano M, Fujishiro T, Toyozumi T, Semba Y, Matsubara H (2019) Short-term clinical outcomes of laparoscopic gastrectomy for remnant gastric cancer: A single-institution experience and systematic review of the literature. Ann Gastroenterol Surg 3(2):181–186. https://doi.org/10.1002/ags3.12221

    Article  PubMed  Google Scholar 

  18. Mak TK, Guan B, Peng J, Chong TH, Wang C, Huang S, Yang J (2021) Prevalence and characteristics of gastric remnant cancer: A systematic review and meta-analysis. Asian J Surg 44(1):11–17. https://doi.org/10.1016/j.asjsur.2020.03.012

    Article  PubMed  Google Scholar 

  19. Kosuga T, Hiki N, Nunobe S, Noma H, Honda M, Tanimura S, Sano T, Yamaguchi T (2014) Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 21(6):2028–2035. https://doi.org/10.1245/s10434-014-3520-1

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Prof. Naoki Hiki (Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan) for his useful advice.

Author information

Authors and Affiliations

  1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Ryota Otsuka, Koichi Hayano & Hisahiro Matsubara

  2. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Chiba, Japan

    Masahiro Yoshida

  3. Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan

    Hironobu Goto

  4. Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Yusuke Muneoka & Souya Nunobe

Authors
  1. Ryota Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koichi Hayano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masahiro Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hironobu Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yusuke Muneoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Souya Nunobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hisahiro Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ryota Otsuka conceived and designed the study. Koichi Hayano and Ryota Otsuka performed the literature search. Hironobu Goto, Yusuke Muneoka, Souya Nunobe, and Ryota Otsuka contributed to the data acquisition, analysis and interpretation. The manuscript was prepared by Ryota Otsuka under the supervision of Koichi Hayano, Masahiro Yoshida, and Hisahiro Matsubara. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ryota Otsuka.

Ethics declarations

Funding

The authors have no funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board of Chiba University (No. 3737).

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and material

Not applicable.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otsuka, R., Hayano, K., Yoshida, M. et al. Subtotal versus total gastrectomy for remnant gastric cancer: a systematic review and meta-analysis of observational studies. Langenbecks Arch Surg 406, 1379–1385 (2021). https://doi.org/10.1007/s00423-021-02144-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-021-02144-6

Keywords

Search

Navigation