Du Nan, Wu Pei, Wang Pengliang, Du Yuwei, Li Kai, Wang Zhenning, Xu Huimian, Zhu Zhi
Department of Surgical Oncology, Department of General Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
Gastroenterol Res Pract. 2020 Jan 16;2020:8179254. doi: 10.1155/2020/8179254. eCollection 2020.
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.
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 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis.
Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time ( < 0.001), 56.58 mL less blood loss ( = 0.03), and 7.4 days shorter hospital stay time ( < 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, = 0.04), lower risk of intestinal obstruction (OR = 0.07, 95%CI = 0.01 to 0.43, = 0.004), and higher risk of reflux esophagitis (OR = 2.47, 95%CI = 1.07 to 5.72, = 0.03).
The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.
近端胃切除术通过开放或腹腔镜手术用于治疗胃上三分之一的原发性胃癌。食管胃吻合术（EG）或空肠间置术（JI）在近端胃切除术后的各种重建方法中广泛应用。我们对EG和JI治疗胃癌进行了一项荟萃分析。
检索PubMed、Embase、MEDLINE、J-STAGE和Cochrane图书馆，确定关于EG和JI的回顾性系列研究。采用加权平均差（WMDs）、比值比（ORs）和95%置信区间（CIs）分析手术相关数据和术后并发症。通过 检验评估异质性，并使用Egger回归检验和敏感性分析评估潜在的发表偏倚。
选取8项研究，纳入496例患者。EG组的手术时间比JI组短44.81分钟（<0.001），失血量少56.58毫升（=0.03），住院时间短7.4天（<0.001）。两组之间，吻合口漏无显著差异；此外，EG组吻合口狭窄风险较低（OR = 0.44, 95%CI = 0.20至0.97, = 0.04），肠梗阻风险较低（OR = 0.07, 95%CI = 0.01至0.43, = 0.004），反流性食管炎风险较高（OR = 2.47, 95%CI = 1.07至5.72, = 0.03）。
我们的研究结果表明，与JI相比，EG在围手术期和短期结果方面具有显著优势。
