Additional gastrectomy in early-stage gastric cancer after non-curative endoscopic resection: a meta-analysis

Abstract

Abstract Background and objective The role of additional gastrectomy after non-curative endoscopic resection remains uncertain. The present meta-analysis aimed to explore the risk factors for early-stage gastric-cancer patients after non-curative endoscopic resection and evaluate the efficacy of additional gastrectomy. Methods Relevant studies that reported additional gastrectomy after non-curative endoscopic resection were comprehensively searched in MedLine, Web of Science and EMBASE. We first investigated the risk factors for residual tumor and lymph-node metastasis after non-curative endoscopic resection and then analysed the survival outcome, including 5-year overall survival (OS) and 5-year disease-free survival, of additional gastrectomy. Results Twenty-one studies comprising 4870 cases were included in the present study. We found that residual tumor was associated with larger tumor size (>3\u2009cm) (odds ratio [OR]\u2009=\u20092.81, P\u2009<\u20090.001), undifferentiated tumor type (OR\u2009=\u20091.78, P\u2009=\u20090.011) and positive horizontal margin (OR\u2009=\u20099.78, P\u2009<\u20090.001). Lymph-node metastasis was associated with larger tumor size (>3\u2009cm) (OR\u2009=\u20091.73, P\u2009<\u20090.001), elevated tumor type (OR\u2009=\u20091.60, P\u2009=\u20090.035), deeper tumor invasion (>SM1) (OR\u2009=\u20092.68, P\u2009<\u20090.001), lymphatic invasion (OR\u2009=\u20094.65, P\u2009<\u20090.001) and positive vertical margin (OR\u2009=\u20092.30, P\u2009<\u20090.001). Patients who underwent additional gastrectomy had longer 5-year OS (hazard ratio [HR]\u2009=\u20090.34, P\u2009<\u20090.001), 5-year disease-free survival (HR\u2009=\u20090.52, P\u2009=\u20090.001) and 5-year disease-specific survival (HR\u2009=\u20090.50, P\u2009<\u20090.001) than those who did not. Moreover, elderly patients also benefited from additional gastrectomy regarding 5-year OS (HR\u2009=\u20090.41, P\u2009=\u20090.001). Conclusions Additional gastrectomy with lymph-node dissection might improve the survival of early-stage gastric-cancer patients after non-curative endoscopic resection. However, risk stratification should be performed to avoid excessive treatment.