Safety and feasibility of subtotal gastrectomy compared with completion total gastrectomy for remnant gastric cancer: A systematic review and meta-analysis.

BACKGROUND

Remnant gastric cancer is an uncommon malignancy with no established optimal surgical approach. Completion total gastrectomy remains the conventional treatment but is technically demanding with high morbidity. Subtotal gastrectomy has been proposed as an organ-preserving alternative, although its oncologic adequacy remains uncertain. Therefore, we performed a systematic review and meta-analysis comparing subtotal gastrectomy with completion total gastrectomy for remnant gastric cancer.

METHODS

A systematic search of PubMed, Embase, and the Cochrane Library identified studies comparing subtotal gastrectomy and completion total gastrectomy in remnant gastric cancer. Meta-analyses employed a random-effects model, with pooled estimates reported as risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Analyses were performed with R (version 4.4.1).

RESULTS

Seven retrospective cohort studies including 601 patients were analyzed, of whom 120 patients (19.97%) underwent subtotal gastrectomy. Subtotal gastrectomy was associated with shorter operative time (MD -39.34 min; p < 0.01) and lower intraoperative blood loss (MD -91.22 mL; p < 0.01). No significant differences were observed in overall survival (HR 0.95; p = 0.8314), recurrence-free survival (HR 0.90; p = 0.4206), margin status (R0), tumor recurrence (9.16% vs 16.42%; RR 0.74; p = 0.34), number of lymph nodes retrieved (MD -0.85; p = 0.53), overall postoperative complications (RR 0.66; p = 0.2478), wound infection, pancreatic fistula, anastomotic leak, or length of hospital stay.

CONCLUSION

Subtotal gastrectomy was associated with improved intraoperative outcomes, with no statistically significant differences observed in oncologic and postoperative outcomes. These findings suggest that subtotal gastrectomy may be a feasible organ-preserving option in selected patients, although further studies are needed.