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Oesophagectomy or Total Gastrectomy for the Management of Siewert II Gastroesophageal Junction Cancer: a Systematic Review and Meta-analysis

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There is no consensus on the ideal surgical management of patients with Siewert type II gastroesophageal junctional (GEJ) cancers. Due to its anatomical location, total gastrectomy and oesophagectomy are widely used methods of resection. The aim of this study was to determine the optimal surgical treatment of these patients.

Method

A systematic search of PubMed, Medline and Cochrane libraries was conducted for literature published between 2000 and 2022. Studies directly comparing oesophagectomy to gastrectomy for Siewert type II tumours were included. Outcome measures included rates of anastomotic leak, 30-day mortality, R0 resection and 5-year survival. Statistical analysis was performed using Review Manager 5.4.

Results

Eleven studies involving 18,585 patients undergoing either oesophagectomy (n = 8618) or total gastrectomy (n = 9967) for Siewert type II GEJ cancer were included. There were no significant differences between the rates of anastomotic leak (OR 0.91, CI 0.59–1.40, p = 0.66) and R0 resection (OR 1.51, CI 0.93–2.42, p = 0.09). Patients undergoing total gastrectomy had a lower 30-day mortality (OR 0.66, CI 0.45–0.95, p = 0.03) and a greater 5-year overall survival (OR 1.49, CI 1.34–1.67, p < 0.001) compared to patients undergoing oesophagectomy. These differences were not statistically significant after excluding two large studies, which accounted for the majority of the total population in the analysis.

Conclusion

These results suggest that total gastrectomy results in lower 30-day mortality and improved overall survival in patients with Siewert type II GEJ cancer. However, interpretation of these results may be biased by the effect of two large studies.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals of Plymouth, Derriford Road, Plymouth, PL6 8DH, UK

    James Walmsley, Arun Ariyarathenam, Richard Berrisford, Lee Humphreys, Grant Sanders, Ji Chung Tham, Tim Wheatley & David S.Y. Chan

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Appendix

Appendix

PRISMA 2020 checklist

Section and topic

Item #

Checklist item

Location where item is reported

Title

 

Title

1

Identify the report as a systematic review

Page 1

Abstract

 

Abstract

2

See the PRISMA 2020 for Abstracts checklist

Page 2

Introduction

 

Rationale

3

Describe the rationale for the review in the context of existing knowledge

Pages 3–4

Objectives

4

Provide an explicit statement of the objective(s) or question(s) the review addresses

Pages 3–4

Methods

 

Eligibility criteria

5

Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses

Page 5

Information sources

6

Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted

Page 4

Search strategy

7

Present the full search strategies for all databases, registers and websites, including any filters and limits used

Pages 4, 17

Selection process

8

Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently and, if applicable, details of automation tools used in the process

Page 4

Data collection process

9

Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators and, if applicable, details of automation tools used in the process

Page 4

Data items

10a

List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g. for all measures, time points, analyses) and, if not, the methods used to decide which results to collect

Pages 4, 15

10b

List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information

Pages 4, 5, 15

Study risk of bias assessment

11

Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently and, if applicable, details of automation tools used in the process

Pages 6, 21

Effect measures

12

Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results

Page 5

Synthesis methods

13a

Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5))

Pages 4, 5

13b

Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions

Pages 4, 5

13c

Describe any methods used to tabulate or visually display results of individual studies and syntheses

Page 5

13d

Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity and software package(s) used

Page 5

13e

Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, meta-regression)

Page 5

13f

Describe any sensitivity analyses conducted to assess robustness of the synthesized results

NA

Reporting bias assessment

14

Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases)

Page 6

Certainty assessment

15

Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome

Pages 4-6

Results

 

Study selection

16a

Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram

Page 17

16b

Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded

Page 7

Study characteristics

17

Cite each included study and present its characteristics

Pages 7, 15

Risk of bias in studies

18

Present assessments of risk of bias for each included study

Pages 9, 21

Results of individual studies

19

For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g. confidence/credible interval), ideally using structured tables or plots

Pages 7, 15

Results of syntheses

20a

For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies

Pages 6–9

20b

Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect

Page 9

20c

Present results of all investigations of possible causes of heterogeneity among study results

Pages 6–9

20d

Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results

Pages 6–9

Reporting biases

21

Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed

Pages 6–9

Certainty of evidence

22

Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed

Pages 6–9

Discussion

 

Discussion

23a

Provide a general interpretation of the results in the context of other evidence

Pages 9–13

23b

Discuss any limitations of the evidence included in the review

Pages 9–13

23c

Discuss any limitations of the review processes used

Pages 9–13

23d

Discuss implications of the results for practice, policy and future research

Pages 9–13

Other information

 

Registration and protocol

24a

Provide registration information for the review, including register name and registration number, or state that the review was not registered

Page 4

24b

Indicate where the review protocol can be accessed, or state that a protocol was not prepared

Page 4

24c

Describe and explain any amendments to information provided at registration or in the protocol

NA

Support

25

Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review

Page 1

Competing interests

26

Declare any competing interests of review authors

Page 1

Availability of data, code and other materials

27

Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review

Pages 4–6

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71

For more information, visit http://www.prisma-statement.org/

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Walmsley, J., Ariyarathenam, A., Berrisford, R. et al. Oesophagectomy or Total Gastrectomy for the Management of Siewert II Gastroesophageal Junction Cancer: a Systematic Review and Meta-analysis. J Gastrointest Surg 27, 1321–1335 (2023). https://doi.org/10.1007/s11605-023-05661-5

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  • DOI: https://doi.org/10.1007/s11605-023-05661-5

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