Clinical Study Of Radical Total Gastrectomy For Advanced Proximal Gastric Cancer

Part one:Clinical study of radical total gastrectomy for advanced proximal gastric cancerObjectiveThe surgical strategy of treating the advanced proximal gastric cancer is controversial. The purpose of this study was to assess the safety, feasibility and oncologic outcomes of radical total gastrectomy.MethodsData on 148 patients with advanced proximal gastric cancer were reviewed. Total gastrectomy (TG) group (n=63) and proximal gastrectomy (PG) group (n=85) were compared for overall complication, anastomotic stricture, reflux esophagitis, body weight changes and hemoglobin changes.ResultsThere was no differences in mortality during intraoperative and hospitalization period between proximal gastrectomy and total gastrectomy. The overall complication was no significant difference (P=0.946), but total gastrectomy can significantly reduce the incidence of anastomotic stricture (P=0.012)and reflux esophagitis(P=0.013); Proximal gastrectomy can effectively maintain the 1、2and 3months postoperative body weight changes (P1=0.001,.P2=0.000, P3=0.003) and postoperative hemoglobin levels (P1=0.000,P2=0.001) in 1、2months.ConclusionTotal gastrectomy may be a feasible and acceptable method for treating advanced proximal gastrectomy in terms of oncologic outcomes. Total gastrectomy can effectively reduce the occurrence of anastomotic stricture, reflux esophagitis and improve the living quality.Part two:Treatment of proximal gastric cancer by total gastrectomy and proximal gastrectomy:Meta analysisObjectiveSystem evaluation of total gastrectomy (TG) and proximal gastrectomy (PG)in the treatment of the proximal gastric cancer.MethodsSearch the databases such as CNKI、CECDB、Medine、Embase、Cochrane library and Web of Science by computer to collect total gastrectomy and proximal gastrectomy for gastric proximal cancer literature, manual retrieval as other ways find the published total gastrectomy and proximal gastrectomy for the treatment of proximal gastric cancer literature. The statistical results including the 5 year overall survival rate, overall complications, anastomotic stenosis, reflux esophagitis, the number of dissected lymph nodes and splenectomy. The statistical data were incorporated into the total gastrectomy group and proximal gastrectomy group. The analyse by Reviews 5.2 software.ResultsTen studies (1426 cases) meet inclusion criteria, including two are randomized controlled studies and eight are retrospective studies. There were no significant differences in 5 years survival rate (RR=1.00,95% CI:[0.981.02];P= 0.55) and overall complications (OR=0.42,95% CI [0.14 1.32];P>0.05).However there were significant differences in anastomotic stenosis (OR=0.28, CI:[0.11 0.72];P<0.05), Reflux esophagitis (OR=0.06,95% CI:[0.02 0.13];P<0.05)and dissected lymph nodes number (MD=12.00,95% CI:[5.02 18.98];P<0.05).Combined splenectomy number (OR=2.21,95%CI:[1.36 3.57];P<0.05)have a significant difference.ConclusionsThere is no difference in 5 years overall survival time between total gastrectomy and proximal gastrectomy. Total gastrectomy can reduce the occurrence of anastomotic stricture and reflux esophagitis, increase the number of lymph node dissection and improve the quality of life.