Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

Nan Du; Pei Wu; Pengliang Wang; Yuwei Du; Kai Li; Zhenning Wang; Huimian Xu; Zhi Zhu

doi:10.1155/2020/8179254

Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

Gastroenterol Res Pract. 2020 Jan 16:2020:8179254. doi: 10.1155/2020/8179254. eCollection 2020.

Authors

Nan Du¹, Pei Wu¹, Pengliang Wang¹, Yuwei Du¹, Kai Li¹, Zhenning Wang¹, Huimian Xu¹, Zhi Zhu¹

Affiliation

¹ Department of Surgical Oncology, Department of General Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.

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 I ² 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.