Min Jae-Seok, Kim Rock Bum, Seo Kyung Won, Jeong Sang-Ho
Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea.
Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Korea.
J Gastric Cancer. 2022 Apr;22(2):83-93. doi: 10.5230/jgc.2022.22.e9.
To analyze the short- and long-term clinical outcomes of 2 reconstruction methods after distal gastrectomy for gastric cancer.
Three keywords, "gastric neoplasm," "distal gastrectomy," and "reconstruction," were used to search PubMed. We selected only randomized controlled trial that compared the anastomosis methods. A total of 11 papers and 8 studies were included in this meta-analysis. All statistical analyses were performed using the R software.
Among short-term clinical outcomes, a shorter operation time, reduced morbidity, and shorter hospital stay were found for Billroth type I (B-I) than for Roux-en-Y (RNY) reconstruction in the meta-analysis (P<0.001, P=0.048, P<0.001, respectively). When comparing Billroth type II (B-II) to RNY, the operation time was shorter for B-II than for RNY (P<0.019), but there were no differences in morbidity or length of hospital stay (P=0.500, P=0.259, respectively). Regarding long-term clinical outcomes related to reflux, there were significantly fewer incidents of reflux esophagitis, reflux gastritis, and bile reflux (P=0.035, P<0.001, P=0.019, respectively) for RNY than for B-I in the meta-analysis, but there was no difference between the 2 methods in residual food (P=0.545). When comparing B-II to RNY, there were significantly fewer incidents of reflux gastritis (P<0.001) for RNY than for B-II, but the amount of residual food and patient weight gain showed no difference.
B-I had the most favorable short-term outcomes, but RNY was more advantageous for long-term outcomes than for other methods. Surgeons should be aware of the advantages and disadvantages of each type of anastomosis and select the appropriate method.
分析胃癌远端胃切除术后两种重建方法的短期和长期临床结局。
使用“胃肿瘤”“远端胃切除术”和“重建”三个关键词检索PubMed。我们仅选择比较吻合方法的随机对照试验。本荟萃分析共纳入11篇论文和8项研究。所有统计分析均使用R软件进行。
在短期临床结局方面，荟萃分析显示，毕Ⅰ式（B-I）重建的手术时间比 Roux-en-Y（RNY）重建短，发病率降低，住院时间缩短（分别为P<0.001、P=0.048、P<0.001）。将毕Ⅱ式（B-II）与RNY比较时，B-II的手术时间比RNY短（P<0.019），但发病率和住院时间无差异（分别为P=0.500、P=0.259）。关于与反流相关的长期临床结局，荟萃分析显示，RNY的反流性食管炎、反流性胃炎和胆汁反流事件明显少于B-I（分别为P=0.035、P<0.001、P=0.019），但两种方法在残食方面无差异（P=0.545）。将B-II与RNY比较时，RNY的反流性胃炎事件明显少于B-II（P<0.001），但残食量和患者体重增加无差异。
B-I的短期结局最有利，但RNY在长期结局方面比其他方法更具优势。外科医生应了解每种吻合方式的优缺点并选择合适的方法。
