Reconstruction methods and postoperative outcome after proximal gastrectomy for gastric cancer in the upper third of the stomach: A systematic review and meta-analysis
Dr. Zakari Shaibu, Zhihong Chen, Said Abdulrahman Salim Mzee, Yu Fang, Jia-cheng Qian, Dr. Acquah Theophilus, Yue-xin Wang
Aim: To systematically review the literature and analyze postoperative outcomes of various reconstructive techniques after proximal gastrectomy. Method: PubMed, Google scholar and Medline were searched for studies and relevant literature published between 1966 and 2017 regarding various reconstructive methods performed during proximal gastrectomy. The postoperative outcomes of the reconstructive techniques were successfully assessed. Meta-analyses were performed by RevMan 5.0. Results: In total, 23 studies were included. The studies investigated postoperative outcomes of double tract reconstruction, double flap reconstruction, jejunal pouch interposition, jejunal interposition, gastric tube, esophagogastrostomy and side to side anastomosis. Pooled incidences of reflux esophagitis for these procedures were, 8.2%,8.9%,13.8%,7.4%,13.2%,12.3% and 12.5% respectively. The five studies were randomized with n=269 participant comparing the postoperative outcomes between JI, JPI and EG were deemed eligible for pooled analyses. Meta-analysis showed no significant difference of reflux esophagitis [Heterogeneity: Chi² = 0.09, df = 1 (P = 0.76); I² = 0%],test for overall effect: Z = 0.24 (P = 0.81).Anastomotic leakage [Heterogeneity: Chi² = 5.20, df = 2 (P = 0.07); I² = 62%],test for overall effect: Z = 0.24 (P = 0.81).Wound infection [Heterogeneity: Chi² = 0.93, df = 1 (P = 0.34); I² = 0%], test for overall effect: Z = 0.42 (P = 0.68). However, analysis of the anastomotic stricture favored the EG group and there was a statistical difference between the two groups [Heterogeneity: Tau² = 0.00; Chi² = 0.05, df = 1 (P = 0.83); I² = 0%], test for overall effect: Z = 2.27 (P = 0.02). Conclusion: The incidence of reflux esophagitis and anastomotic complications associated with PG was not different among the various reconstructive methods currently under study, but reflux esophagitis and anastomotic stricture were relatively common. PG following jejunal pouch interposition, esophagogastrostomy, side to side anastomosis showed higher incidence of reflux esophagitis. Jejunal interposition and jejunal pouch interposition also showed higher incidence of anastomotic stricture. However optimal reconstruction method is still under study in other to decrease the incidence of postoperative outcome.