Proximal Gastrectomy And Double Tract Reconstruction Vs Total Gastrectomy In Gastric And Gastro Esophageal Junction Cancer Patients A Systematic Review And Meta Analysis Protocol Prospero Registration Number Crd42021291500
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| Author | : Julian Hipp |
| Publisher | : |
| Total Pages | : 0 |
| Release | : 2023 |
| Genre | : |
| ISBN | : |
Abstract: Background In Germany and Western Europe, gastroesophageal junction cancer (AEG) and proximal gastric cancer are currently treated with (transhiatal-extended) total gastrectomy (TG) according to the latest treatment guidelines. TG leads to a severe and long-lasting impairment of postoperative health-related quality of life (HRQoL) of the treated patients. Recent studies have suggested that HRQoL of these patients could be improved by proximal gastrectomy with double-tract reconstruction (PG-DTR) without compromising oncologic safety. Our aim is therefore to conduct a randomized controlled non-inferiority trial comparing PG-DTR with TG in AEG II/III and gastric cancer patients with overall survival as primary endpoint and HRQoL as key secondary endpoint. Methods This protocol is written with reference to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P 2015) statement. We will conduct searches in the electronic databases MEDLINE, Web of Science Core Collection, ScienceDirect, and Cochrane Library. We will also check references of relevant studies and perform a cited reference research. Titles and abstracts of the records identified by the searches will be screened, and full texts of all potentially relevant articles will be obtained. We will consider randomized trials and non-randomized studies. The selection of studies, data extraction, and assessment of risk of bias of the included studies will be conducted independently by two reviewers. Meta-analysis will be performed using RevMan 5.4 (Review Manager (RevMan) Version 5.4, The Cochrane Collaboration). Discussion This systematic review will identify the current study pool concerning the comparison of TG and PG-DTR and help to finally refine the research questions and to allow an evidence-based trial design of the planned multicenter randomized-controlled trial. Ethics and dissemination Ethical approval is not required for this systematic review. Study findings will be shared by publication in a peer-reviewed journal
| Author | : Julian Hipp |
| Publisher | : |
| Total Pages | : 0 |
| Release | : 2023 |
| Genre | : |
| ISBN | : |
Abstract: Background To compare proximal gastrectomy with double-tract reconstruction and total gastrectomy in patients with gastroesophageal junction (AEG II-III) and gastric cancer. Methods We conducted systematic searches in Medline, Web of Science, and Cochrane Library until December 20, 2021 (PROSPERO registration number: CRD42021291500). Risk of bias was assessed using the revised Cochrane risk of bias tool and the ROBINS-I tool, as applicable. Evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results One randomized controlled trial (RCT) and 13 non-RCTs with 1,317 patients (715 patients with total gastrectomy and 602 patients with proximal gastrectomy with double-tract reconstruction) were included. Patients treated by total gastrectomy had a significantly higher proportion of advanced cancer stages International Union Against Cancer IB-III (odds ratio: 0.68, 95% confidence interval: 0.51-0.91, P = .01). This heterogeneity biases the observed improved overall survival of patients after proximal gastrectomy with double-tract reconstruction (odds ratio: 0.67, 95% confidence interval: 0.44-1.01, P = .05). Both procedures were comparably efficient regarding perioperative parameters. Postoperative/preoperative bodyweight ratio (mean difference: 3.56, 95% confidence interval: 1.32-5.79, P = .002), postoperative/preoperative serum-hemoglobin ratio (mean difference 3.73, 95% confidence interval: 1.59-5.88, P .001), and postoperative serum vitamin B12 levels (mean difference 42.46, 95% confidence interval: 6.37-78.55, P = .02) were superior after proximal gastrectomy with double-tract reconstruction, while postoperative/preoperative serum-albumin ratio (mean difference 1.24, 95% confidence interval: -4.76 to 7.24, P = .69) and postoperative/preoperative serum total protein ratio (mean difference 1.12, 95% confidence interval: -2.77 to 5.00, P = .57) were not different. Health-related quality of life data were reported in only 2 studies, which found no significant advantages for proximal gastrectomy with double-tract reconstruction.brbrConclusion
| Author | : Walter Siquini |
| Publisher | : Springer |
| Total Pages | : 222 |
| Release | : 2015-05-05 |
| Genre | : Medical |
| ISBN | : 8847057493 |
This richly illustrated volume describes the performance of total and subtotal gastrectomy with extended D2 lymphadenectomy by providing a detailed step-by-step guide to both manual and mechanical procedures. Gastric cancer is the fourth most commonly occurring cancer and the second most common cancer-related cause of death worldwide, and surgery remains the only potentially curative treatment. Although several aspects of surgical management are still controversial, all guidelines for the treatment of curable gastric cancer recommend subtotal gastrectomy (for tumors located in the antrum and corpus) or total gastrectomy (for tumors located in the fundus) with extended D2 lymphadenectomy. Various technical tips and secrets are revealed that serve to simplify the procedure and simultaneously make it more effective: by rendering esophagojejunal and gastrojejunal anastomosis more secure, the risk of leakage is minimized. High-quality intraoperative color photographs and drawings covering all steps facilitate understanding of these complex operations and will prove an invaluable tool for surgeons, residents and professionals in the field.
