Abstract
Background Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P < 0.001), 56.58 mL less blood loss (P = 0.03), and 7.4 days shorter hospital stay time (P < 0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR = 0.44, 95%CI = 0.20 to 0.97, P = 0.04), lower risk of intestinal obstruction (OR = 0.07, 95%CI = 0.01 to 0.43, P = 0.004), and higher risk of reflux esophagitis (OR = 2.47, 95%CI = 1.07 to 5.72, P = 0.03). Conclusion The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.
Highlights
Proximal gastric cancer is characterized by large tumor size, high incidence of lymph node metastasis, strong invasive ability, and poor prognosis
Five articles had available data on operating time; four of which demonstrated that EG had a shorter operating time than jejunal interposition (JI) had (WMD = ‐44:81, 95%confidence intervals (CIs) = ‐70:46 to‐19:16, P < 0:001)
The heterogeneity between the groups was high in the random-effects model (I2 = 79%, P < 0:001) (see Figure 2(a)), which disappeared (I2=0, P = 0:40) when Yasuda 2015 trial was excluded; the Weight mean differences (WMDs) ranged from -44.81 to -54.96
Summary
Proximal gastric cancer is characterized by large tumor size, high incidence of lymph node metastasis, strong invasive ability, and poor prognosis. The incidence of proximal gastric cancer has increased significantly in China in recent years [1]. JGCA treatment guidelines indicate that proximal gastrectomy (PG) should only be performed for early gastric cancer, and at least half of the stomach should be preserved to maintain physiological function of the remnant stomach by open or laparoscopic surgery [2]. Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer.
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