LU Yingjie 1,2 , HONG Ziqiang 1 , LI Hongchao 1 , JIN Gang 2 , WANG Wenhao 2 , YANG Yi 2 , LIU Bin 2 , ZHU Zijiang 2
  • 1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China;
  • 2. Department of Thoracic Surgery Ⅱ, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;
ZHU Zijiang, Email: hi15956940066@163.com
Adenocarcinoma of the esophagogastric junction; Proximal gastrectomy; Total gastrectomy; Siewert Ⅱ/Ⅲ; Systematic review/meta-analysis
10.7507/1007-4848.202305002
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Objective The main objective of this study is to systematically evaluate the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction. Methods This study conducted a meta-analysis using Review Manager 5.4 software to compare the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang Data, and VIP were searched for relevant literature published through March 2023. Results This study included a total of 23 articles, among which 16 were retrospective studies, 5 were prospective studies, and 2 were RCT. In total, 2826 patients, 1389 patients underwent proximal gastrectomy and 1437 patients underwent total gastrectomy. Meta-analysis showed that proximal gastrectomy had less intraoperative bleeding than total gastrectomy [MD=-19.85, 95% CI (-37.20, -2.51), P=0.02] and shorter postoperative hospital stay. Total gastrectomy had a higher number of lymph node dissections than proximal gastrectomy [MD=-6.20, 95% CI (-7.68, -4.71), P<0.00001] and a lower incidence of reflux esophagitis [MD=3.02, 95% CI (1.24, 7.34), P=0.01]. In contrast, there was no statistically significant difference between the two procedures in terms of operative time, postoperative OS (1-year OS, 3-year OS, 5-year OS) and total postoperative complications (P>0.05). Conclusion Proximal gastrectomy had an advantage in terms of intraoperative bleeding and postoperative length of stay, whereas total gastrectomy had an advantage in terms of number of lymph nodes cleared and incidence of reflux esophagitis, with no significant difference in long-term survival between the two procedures.