Meta-analysis of the efficacy of applying reduced surgery for the treatment of asymptomatic unresectable advanced gastric cancer.

OBJECTIVES

Systematic evaluation of the efficacy and safety of reduction surgery in asymptomatic unresectable advanced gastric cancer.

MATERIALS AND METHODS

PubMed, EMBASE, Cochrane Library and Web of Science were searched from database inception to 12 July 2024. The Cochrane Risk of Bias Assessment Tool and Newcastle-Ottawa Scale were used to evaluate the quality and analyze the bias of the randomized controlled and non-randomized controlled studies included in this study, and RevMan (Version 5.4) was used to perform the meta-analysis.

RESULTS

A total of 5 studies were finally included, including 1 randomized controlled study and 4 retrospective studies. The cumulative sample size was 1717 cases, including 701 cases in the reduced surgery group and 1016 cases in the non-surgical treatment group. The results of the Meta-analysis showed that the reduced surgery group did not offer a survival benefit compared with the non-surgical treatment group in terms of 1-year, 3-year, and 5-year survival rates. The reduced surgery group had a longer median survival time than the non-surgical group by 11.58 months. The incidence rate, morbidity rate, and mortality rate of the reduced surgery group were 5.5% and 6.5% higher than those of the non-surgical group, respectively. The incidence of perioperative complications and death rate in the reduced surgery group were 15% and 4%, respectively; about 3% of patients might have complications of the primary foci during non-surgical treatment and need palliative surgical resection.

CONCLUSION

Current evidence suggests that in asymptomatic patients with unresectable advanced gastric cancer, reduced surgery with resection of the primary site does not result in a long-term survival benefit. We look forward to more high-quality randomized controlled trials to provide more substantial evidence to support clinical practice.