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Inicio Cirugía Española (English Edition) Comparative study between total and subtotal gastrectomy for distal gastric canc...
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Vol. 98. Issue 10.
Pages 582-590 (December 2020)
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Vol. 98. Issue 10.
Pages 582-590 (December 2020)
Review article
DOI: 10.1016/j.cireng.2020.11.013
Comparative study between total and subtotal gastrectomy for distal gastric cancer: Meta-analysis of prospective and retrospective studies
Estudio comparativo entre la gastrectomía total y subtotal en el cáncer distal de estómago: metaanálisis de estudios prospectivos y retrospectivos
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Hipólito Durán Giménez-Ricoa,b,
Corresponding author
hduran@hmhospitales.com

Corresponding author.
, Lucía Diéguez Aguirrea, Lucía Ríos Péreza, Pablo Cardinal-Fernándezc, Riccardo Carusoa,b, Valentina Ferria,b, Yolanda Quijano Collazoa,b,d, Emilio Vicente Lópeza,b,d
a Servicio de Cirugía General, Departamento de Ciencias Médicas Clínicas (Sección de Cirugía), Hospital Universitario HM Sanchinarro, Universidad San Pablo CEU, Madrid, Spain
b Fundación para el Desarrollo e Investigación de Cirugía Oncológica, Madrid, Spain
c Departamento de Cuidados Intensivos, Hospital Universitario HM Sanchinarro, Madrid, Spain
d Cátedra Internacional de Investigación en Cirugía General y Digestiva, Universidad Católica de Murcia, Murcia, Spain
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Table 1. Characteristics of the articles included in the meta-analysis.
Table 2. Summary of the statistics obtained from the comparison between DG and TG.
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Abstract

There is no clear agreement on the type of gastrectomy to be used (either total [TG] or distal [DG]) in middle or distal gastric cancer, especially when it is undifferentiated or Lauren diffuse type. In this meta-analysis, we intend to define which of the two techniques should be recommended, based on survival, morbidity and mortality rates. Prospective and retrospective studies comparing both techniques have been included for a total of 6303 patients (3,641 DG and 2,662 TG). DG was significantly associated with fewer complications, fewer anastomotic fistulae, and less perioperative mortality. The number of lymph nodes in DG was significantly lower, but always above 15. Finally, even the 5-year survival of DG was also higher. Therefore, distal gastrectomy, as long as a safety margin is obtained and regardless of the histological type, should be performed in surgery for distal stomach cancer.

Keywords:
Gastric cancer
Gastrectomy
Total gastrectomy
Subtotal gastrectomy
Resumen

El tipo de gastrectomía, total (GT) o distal (GD), en el cáncer gástrico medio o distal no está claramente consensuada, sobre todo cuando es indiferenciado o difuso de Lauren. Pretendemos en este metaanálisis definir en términos de supervivencia y morbimortalidad cuál de las dos técnicas debiera ser recomendada. Se han incluido trabajos prospectivos y retrospectivos que comparen ambas técnicas hasta un total de 6303 pacientes (3.641 GD y 2.662 GT). La GD se asoció de forma significativa con menos complicaciones, menos fístulas anastomóticas y menos mortalidad peroperatoria. El número de ganglios en la GD fue significativamente menor, pero siempre por encima de 15. Finalmente, la supervivencia a cinco años de la GD fue también superior. Por tanto, la gastrectomía distal, siempre que se obtenga un margen de seguridad e independientemente del tipo histológico, debe ser realizada en la cirugía de cáncer distal de estómago.

Palabras clave:
Cáncer gástrico
Gastrectomía
Gastrectomía subtotal
Gastrectomía total

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