Distal versus total gastrectomy for middle and lower-third gastric cancer: A systematic review and meta-analysis

Int J Surg. 2018 May:53:163-170. doi: 10.1016/j.ijsu.2018.03.047. Epub 2018 Mar 27.


Background: The optimal resection extent for middle or lower-third gastric cancer still remains controversial. This study was aim to compare the safety and long-term prognosis of distal gastrectomy (DG) with total gastrectomy (TG) for middle and lower-third gastric cancer.

Methods: Pubmed, EMBASE, the Cochrane Library, and Web of Science were searched from inception to October 2017 for comparative studies comparing DG with TG for middle or lower-third gastric cancer. We performed the meta-analysis using RevMan 5.3 software.

Results: Overall, 11 comparative studies with 3554 patients, including 4 randomized controlled trials and 7 retrospective cohort studies, were analyzed. Compared with DG, TG showed a higher rate of overall postoperative complication, anastomosis leakage, wound complication, peritoneal abscess, and mortality. There were no significant differences between the two groups in rate of recurrence and cancer-related death. The 5-year overall survival is better in the DG group than in the TG group, but no significant differences were found in stage-specific analysis.

Conclusions: Compared with TG, DG is an optimal surgical procedure for middle or lower-third gastric cancer in early and locally advanced stages with better short-term outcomes and comparable long-term prognosis under the precondition of negative proximal resection margin.

Keywords: Distal gastrectomy; Gastric cancer; Meta-analysis; Total gastrectomy.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Gastrectomy / adverse effects
  • Gastrectomy / methods*
  • Humans
  • Postoperative Complications / epidemiology
  • Prognosis
  • Stomach Neoplasms / diagnosis
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / surgery*
  • Survival Rate