Impact of spleen-preserving total gastrectomy on postoperative infectious complications and 5-year overall survival: systematic review and meta-analysis of contemporary randomized clinical trials

[摘要] BackgroundThe role of splenectomy in proximal gastric cancer is still debated. The objective of the present metaanalysis was to provide more-robust evidence about the effect of spleen-preserving total gastrectomy on postoperative infectious complications, overall morbidity, and 5-year overall survival (os). MethodsPubMed, embase, and the Web of Science were consulted . Pooled effect measures were calculated using an inverse-variance weighted or Mantel–Haenszel in random effects meta-analysis. Heterogeneity was evaluated usingI 2 index and CochranQ- test. ResultsThree randomized controlled trials published between 2000 and 2018 were included. Overall, 451 patients (50.1%) underwent open total gastrectomy with spleen preservation and 448 (49.9%) underwent open total gastrectomy with splenectomy. The patients ranged in age from 24 to 78 years. No differences were found in the number of harvested lymph nodes ( p= 0.317), the reoperation rate ( p= 0.871), or hospital length of stay ( p= 0.347). The estimated pooled risk ratios for infectious complications, overall morbidity, and mortality were 1.53 [95% confidence interval (ci): 1.09 to 2.14;p= 0.016], 1.51 (95% ci: 1.11 to 2.05;p= 0.008), and 1.23 (95% ci: 0.40 to 3.71;p= 0.719) respectively. The estimated pooled hazard ratio for 5-year os was 1.06 (95% ci: 0.78 to 1.45;p= 0.707). ConclusionsSpleen-preserving total gastrectomy should be considered in patients with curable gastric cancer because it is significantly associated with decreased postoperative infectious complications and overall morbidity, with no difference in the 5-year os. Those observations appear worthwhile for establishing better evidence-based treatment for gastric cancer.

[学科分类] 肿瘤学

[关键词] Gastric cancer;splenectomy;spleen preservation;infectious complications;5-year overall survival