IBC-Oxford University2023_BJSOral_14Onco-metabolic Surgery: The Metabolic Effects and Effectiveness of the Different Reconstruction Methods used in Gastric Cancer Surgery. A Systematic Review and Meta-analysis

Abstract

Abstract Introduction Gastric Cancer (GC) is the fifth most common cancer worldwide. With the development of screening programmes, early stages of GC began being detected, giving rise to a new concern: Quality of Life. Traditional surgical techniques for GC can be tailored and adjusted based on the principles of metabolic and bariatric surgery to optimise therapeutic benefits without sacrificing oncological safety. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HT), and body mass index (BMI) reduction rate and to provide an overview of recent research on Onco-metabolic Surgery (OS). Methods We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a metaanalysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y (RY) reconstruction, and residual stomach on T2DM, HT and BMI reduction rate. Heterogeneity was assessed using the I2 statistics. Results We included 31 studies in the qualitative synthesis and 18 in the quantitative synthesis. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative partial and complete remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95%CI) [1.27; 1.62]) and 1.3 (95%CI [1.00; 1.69]), respectively. Compared with the Billroth II group, RY reconstruction had significantly greater T2DM remission after gastrectomy (RR=1.19; 95%CI [1.08; 1.31]), while HBP showed no statistically significant differences. Regarding improvement in HT, total gastrectomy was significantly superior to subtotal gastrectomy (95%CI [1.01; 2.64]). Although there were no significant differences in the extent of gastrectomy, a trend towards RY oesophagojejunostomy as the best option for T2DM remission was observed (95%CI [0.98; 2.77]; p=0.06). Conclusion Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Gastrectomy with long-limb Roux-en-Y reconstruction should be considered for patients with early-stage GC, concomitant metabolic diseases, and no surgery contraindications. Further research is needed to assess the impact of OS on metabolic diseases.