Abstract / Summary
The optimal extent of gastric resection for adenocarcinoma of the esophagogastric junction and proximal gastric cancer remains controversial. This systematic review and meta-analysis aimed to compare the perioperative outcomes, postoperative complications, and long-term nutritional outcomes of proximal gastrectomy (PG) versus total gastrectomy (TG) in randomized controlled trials. We systematically searched the PubMed, Embase, Cochrane Library, and Web of Science databases for articles published in English from inception to June 2024. Our evaluated endpoints were surgery-related indexes, postoperative complications, and long-term nutritional outcomes. A total of 816 patients in six randomized controlled trials were analyzed. Compared with the TG group, the PG group had a lower number of retrieved lymph nodes (weighted mean difference − 10.42, 95% confidence interval (CI) − 16.61– −4.24, p = 0.001), lower incidence of dumping syndrome (odds ratio (OR) 0.37, 95% CI 0.16– 0.87, p = 0.02), and smaller proportion of patients who required vitamin B12 supplementation (OR 0.13, 95% CI 0.05– 0.28, p < 0.00001). Subgroup analyses showed that the double-tract reconstruction group had a lower incidence of reflux esophagitis than the TG group (OR 0.24, 95% CI 0.11– 0.52, p = 0.0003), and that the operation time was longer in the jejunal interposition group than in the TG group (weighted mean difference 1.08, 95% CI 0.06– 2.10, p = 0.04). PG was superior to TG in terms of long-term nutritional outcomes and reflux esophagitis. The double-tract reconstruction group achieved comparable perioperative outcomes to the TG group and showed superiority in improving the nutritional status and reducing the incidence of reflux esophagitis.