Advantages of subtotal gastrectomy for upper third gastric cancer: A systematic review and meta-analysis

Distal gastrectomy with very small remnant stomach (subtotal gastrectomy, STG) is sometimes performed for upper third gastric cancer, instead of total gastrectomy (TG). However, the advantages of STG over TG remain fully unknown, in terms of survival outcomes, complication rates, nutritional status, and quality of life. Therefore, a systematic review was performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting systematic reviews. Meta-analyses were performed regarding operation time, complication rates, body weight changes, and reflux esophagitis by using R software. Operation time was significantly shorter in STG than in TG (Mean difference: -20.79 [95% CI: -35.59 to -5.99]). We cannot conclude whether STG is better than TG in terms of survival because of inconsistency among reports. The total complication rates (≧ grade2 and 3) are significantly lower in STG than TG. Reflux esophagitis was lower in STG than in TG (0% vs. 7.7%), although the difference was not significant probably because of small sample size. Body weight change compared with preoperative value was significantly lower after STG than TG both at 6 and 12 months after the operation (6 months: mean difference -5.31% [95% CI: -6.95 to -3.67], 12 months: mean difference -6.13 [95% CI: -8.20 to -4.06]). We revealed that STG has its advantage on shorter operation time, less complication rates, and lower body weight loss by meta-analysis. Although there are some controversies, STG can be an ideal option for patients with gastric cancer of upper third stomach.