Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis
Abstract Background The optimal reconstruction method after proximal gastrectomy remains unclear. This systematic review and meta-analysis aimed to compare the short-term outcomes and long-term quality of life of various reconstruction methods. Methods PubMed, Embase, Web of Science and Cochrane Lib...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-01-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-024-11827-4 |
| _version_ | 1827382128562667520 |
|---|---|
| author | Bailong Li Yinkui Wang Baocong Li Fei Shan Ziyu Li |
| author_facet | Bailong Li Yinkui Wang Baocong Li Fei Shan Ziyu Li |
| author_sort | Bailong Li |
| collection | DOAJ |
| description | Abstract Background The optimal reconstruction method after proximal gastrectomy remains unclear. This systematic review and meta-analysis aimed to compare the short-term outcomes and long-term quality of life of various reconstruction methods. Methods PubMed, Embase, Web of Science and Cochrane Library were searched to identify comparative studies concerning the reconstruction methods after proximal gastrectomy. The reconstruction methods were classified into six groups: double tract reconstruction (DTR), esophagogastrostomy (EG), gastric tube reconstruction (GT), jejunal interposition (JI), jejunal pouch interposition (JPI) and double flap technique (DFT). Esophagogastric anastomosis group (EG group) included EG, GT and DFT, while esophagojejunal anastomosis group (EJ group) included DTR, JI and JPI. Results A total of 27 studies with 2410 patients were included in this meta-analysis. The pooled results indicated that the incidences of reflux esophagitis of DTR, EG, GT, JI, JPI and DFT were 7.6%, 27.3%, 4.5%, 7.1%, 14.0%, and 9.1%, respectively. The EG group had more reflux esophagitis (OR = 3.68, 95%CI 2.44–5.57, P < 0.00001) and anastomotic stricture (OR = 1.58, 95%CI 1.02–2.45, P = 0.04) than the EJ group. But the EG group showed shorter operation time (MD=-56.34, 95%CI -76.75- -35.94, P < 0.00001), lesser intraoperative blood loss (MD=-126.52, 95%CI -187.91- -65.12, P < 0.0001) and shorter postoperative hospital stay (MD=-2.07, 95%CI -3.66- -0.48, P = 0.01). Meanwhile, the EG group had fewer postoperative complications (OR = 0.68, 95%CI 0.51–0.90, P = 0.006) and lesser weight loss (MD=-1.25, 95%CI -2.11- -0.39, P = 0.004). For specific reconstruction methods, there were lesser reflux esophagitis (OR = 0.10, 95%CI 0.06–0.18, P < 0.00001) and anastomotic stricture (OR = 0.14, 95%CI 0.06–0.33, P < 0.00001) in DTR than the esophagogastrostomy. DTR and esophagogastrostomy showed no significant difference in anastomotic leakage (OR = 1.01, 95%CI 0.34–3.01, P = 0.98). Conclusion Esophagojejunal anastomosis after proximal gastrectomy can reduce the incidences of reflux esophagitis and anastomotic stricture, while esophagogastric anastomosis has advantages in technical simplicity and long-term weight status. Double tract reconstruction is a safe technique with excellent anti-reflux effectiveness and favorable quality of life. Registration This meta-analysis was registered on the PROSPERO (CRD42022381357). |
| first_indexed | 2024-03-08T14:15:04Z |
| format | Article |
| id | doaj.art-54c7a5221fe74010b96d5d09ee59dce8 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-03-08T14:15:04Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-54c7a5221fe74010b96d5d09ee59dce82024-01-14T12:26:33ZengBMCBMC Cancer1471-24072024-01-0124111510.1186/s12885-024-11827-4Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysisBailong Li0Yinkui Wang1Baocong Li2Fei Shan3Ziyu Li4Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and InstituteKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and InstituteKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and InstituteKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and InstituteKey laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and InstituteAbstract Background The optimal reconstruction method after proximal gastrectomy remains unclear. This systematic review and meta-analysis aimed to compare the short-term outcomes and long-term quality of life of various reconstruction methods. Methods PubMed, Embase, Web of Science and Cochrane Library were searched to identify comparative studies concerning the reconstruction methods after proximal gastrectomy. The reconstruction methods were classified into six groups: double tract reconstruction (DTR), esophagogastrostomy (EG), gastric tube reconstruction (GT), jejunal interposition (JI), jejunal pouch interposition (JPI) and double flap technique (DFT). Esophagogastric anastomosis group (EG group) included EG, GT and DFT, while esophagojejunal anastomosis group (EJ group) included DTR, JI and JPI. Results A total of 27 studies with 2410 patients were included in this meta-analysis. The pooled results indicated that the incidences of reflux esophagitis of DTR, EG, GT, JI, JPI and DFT were 7.6%, 27.3%, 4.5%, 7.1%, 14.0%, and 9.1%, respectively. The EG group had more reflux esophagitis (OR = 3.68, 95%CI 2.44–5.57, P < 0.00001) and anastomotic stricture (OR = 1.58, 95%CI 1.02–2.45, P = 0.04) than the EJ group. But the EG group showed shorter operation time (MD=-56.34, 95%CI -76.75- -35.94, P < 0.00001), lesser intraoperative blood loss (MD=-126.52, 95%CI -187.91- -65.12, P < 0.0001) and shorter postoperative hospital stay (MD=-2.07, 95%CI -3.66- -0.48, P = 0.01). Meanwhile, the EG group had fewer postoperative complications (OR = 0.68, 95%CI 0.51–0.90, P = 0.006) and lesser weight loss (MD=-1.25, 95%CI -2.11- -0.39, P = 0.004). For specific reconstruction methods, there were lesser reflux esophagitis (OR = 0.10, 95%CI 0.06–0.18, P < 0.00001) and anastomotic stricture (OR = 0.14, 95%CI 0.06–0.33, P < 0.00001) in DTR than the esophagogastrostomy. DTR and esophagogastrostomy showed no significant difference in anastomotic leakage (OR = 1.01, 95%CI 0.34–3.01, P = 0.98). Conclusion Esophagojejunal anastomosis after proximal gastrectomy can reduce the incidences of reflux esophagitis and anastomotic stricture, while esophagogastric anastomosis has advantages in technical simplicity and long-term weight status. Double tract reconstruction is a safe technique with excellent anti-reflux effectiveness and favorable quality of life. Registration This meta-analysis was registered on the PROSPERO (CRD42022381357).https://doi.org/10.1186/s12885-024-11827-4Gastric cancerProximal gastrectomyDigestive tract reconstructionShort-term outcomeQuality of lifeMeta-analysis |
| spellingShingle | Bailong Li Yinkui Wang Baocong Li Fei Shan Ziyu Li Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis BMC Cancer Gastric cancer Proximal gastrectomy Digestive tract reconstruction Short-term outcome Quality of life Meta-analysis |
| title | Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis |
| title_full | Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis |
| title_fullStr | Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis |
| title_full_unstemmed | Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis |
| title_short | Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis |
| title_sort | short term outcomes and long term quality of life of reconstruction methods after proximal gastrectomy a systematic review and meta analysis |
| topic | Gastric cancer Proximal gastrectomy Digestive tract reconstruction Short-term outcome Quality of life Meta-analysis |
| url | https://doi.org/10.1186/s12885-024-11827-4 |
| work_keys_str_mv | AT bailongli shorttermoutcomesandlongtermqualityoflifeofreconstructionmethodsafterproximalgastrectomyasystematicreviewandmetaanalysis AT yinkuiwang shorttermoutcomesandlongtermqualityoflifeofreconstructionmethodsafterproximalgastrectomyasystematicreviewandmetaanalysis AT baocongli shorttermoutcomesandlongtermqualityoflifeofreconstructionmethodsafterproximalgastrectomyasystematicreviewandmetaanalysis AT feishan shorttermoutcomesandlongtermqualityoflifeofreconstructionmethodsafterproximalgastrectomyasystematicreviewandmetaanalysis AT ziyuli shorttermoutcomesandlongtermqualityoflifeofreconstructionmethodsafterproximalgastrectomyasystematicreviewandmetaanalysis |