Introduction: The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis. Methods: We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes. Results: A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08–4.50]; p = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85–5.99]; p < 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = −10.46 [95% CI: −12.76 to −8.17]; p < 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03–1.77]; p = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59–2.45]; p = 0.62). Conclusion: In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.

中文翻译：

---

近端胃癌切除术与全胃切除术治疗近端胃癌的临床结果：系统评价和荟萃分析

介绍：近端胃癌（PGC）的最佳胃切除范围仍然存在争议，尚未达成最终共识。本研究旨在通过荟萃分析比较近端胃切除术 (PG) 与全胃切除术 (TG) 治疗 PGC 的围手术期结果、术后并发症和总生存期 (OS)。方法：我们系统地搜索了 PubMed、Embase、Cochrane 图书馆和科学网，寻找自数据库建立至 2019 年 10 月发表的英文文章。评估终点包括围手术期结局、术后并发症和长期生存结局。结果：共纳入25篇全文文章2896例患者，其中一项为前瞻性随机研究，一项为临床III期试验，其余为回顾性比较研究。PG 组吻合口狭窄（OR = 2.21 [95% CI: 1.08–4.50]; p = 0.03）和反流症状（OR = 3.33 [95% CI: 1.85–5.99]; p < 0.001）的发生率更高与TG组相比，双道重建（DTR）的PG患者无差异。TG 组中回收的淋巴结明显更多（WMD = -10.46 [95% CI：-12.76 至 -8.17]；p < 0.001）。PG 组与 TG 相比具有更好的 5 年 OS，其中 11 项纳入研究（OR = 1.35 [95% CI：1.03–1.77]；p = 0.03）。然而，在对早期胃癌和 PG 与 DTR 组进行分层后，两组之间没有显着差异（OR = 1.35 [95% CI：0.59–2.45]；p = 0.62）。结论：总之，无论肿瘤分期如何，PG 都与明显改善的长期生存结果相关，而两组之间仅早期胃癌患者的 5 年 OS 相似。未来食管空肠吻合技术的随机临床试验，如 PG 后的 DTR，有望预防术后并发症并协助外科医生为 PGC 患者选择手术方法。