Clinical Outcomes According to Surgical Strategies in Proximal Early Gastric Cancer: A Systematic Review and Network Meta-Analysis.

PURPOSE: Many surgical methods have been developed for the optimal treatment of proximal early gastric cancer (GC); however, these approaches are still controversial. Proximal gastrectomy with direct esophagogastrostomy (EG), double-tract reconstruction (DTR), and double flap-technique (DFT) are considered function-preserving surgeries for proximal early GC rather than total gastrectomy (TG). We conducted a systematic review and network meta-analysis comparing EG, DTR, DFT, and TG to determine the surgical strategy for proximal GC. MATERIALS AND METHODS: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies that compared at least two of the following: EG, DTR, DFT, and TG. Then, we conducted a frequentist network meta-analysis to evaluate the clinical outcomes of 4 surgical methods. RESULTS: We included 38 studies and 3,497 patients. In this study, 15.4% of patients underwent EG, 39.2% DTR, 10.9% DFT, and 34.5% TG. Reflux esophagitis was statistically higher in EG than it was in DFT and DTR. Anastomotic stenosis was significantly lower in DTR than it was in EG. The 12-month postoperative hemoglobin level was the highest in DFT. DTR showed a significantly higher level than EG and TG. TG had the significantly lowest postoperative 12-month total protein level. For operative time, DFT showed the longest duration, and DTR showed a significantly longer duration than EG. For the first flatus time, DFT was the fastest, and DTR was significantly faster than TG. Regarding hospital length of stay, DFT was statistically shorter than the others. CONCLUSIONS: DTR and DFT are more favorable methods than EG and TG, each with distinct advantages. TRIAL REGISTRATION: PROSPERO Identifier: CRD42024598575.