Xi'an Medical University, Xi'an, China.
Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.
Int J Surg. 2022 Jun;102:106684. doi: 10.1016/j.ijsu.2022.106684. Epub 2022 May 19.
Totally laparoscopic total gastrectomy for gastric cancer is limited to few expert surgeons, and a reason for this is the technical difficulty of performing esophagojejunostomy laparoscopically. Overlap has acted as a more popular reconstruction method in recent years; however, its clinical outcomes are inconclusive. Thus, this meta-analysis aimed to provide a higher level of evidence to demonstrate the safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy.
PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to November 2021 for published English literature on retrospective research, prospective research, and randomized controlled trials of overlap anastomosis versus other anastomoses. Basic information and observation indicators of the included articles were extracted. The Cochrane Risk of Bias tool was used by the same researchers to independently assess the risk of bias in the included randomized controlled trials and evaluate the quality of cohort studies using the Newcastle-Ottawa scale. Review Manager 5.3 was used to produce forest plots for meta-analysis, funnel plots were used to assess publication bias, and sensitivity analysis was performed to evaluate result stability.
Overall, 1534 patients from 12 studies were included in this study (738 in and 796 in the overlap and non-overlap groups, respectively). Meta-analysis of the inclusion indicators showed a lower incidence of anastomotic stenosis (OR = 0.19, 95% confidence interval [CI]: 0.09 to 0.41, P < 0.0001) compared with other anastomosis methods, with significant differences in both groups. However, no significal differences were noted between the two groups with respect to operative time (WMD = 13.79, 95% CI: -5.41 to 32.98, P = 0.16), anastomotic time (WMD = 7.18，95% CI: -5.34 to 19.69, P = 0.26), intraoperative blood loss (WMD = 19.96, 95% CI: -17.80 to 57.72, P = 0.30), number of retrieved lymph nodes (WMD = -1.33, 95% CI: -6.24 to 3.57, P = 0.59), time to first flatus (WMD = -0.11, 95% CI: -0.25 to 0.04, P = 0.14), postoperative hospital stay (WMD = -0.09, 95% CI: -1.59 to 1.41, P = 0.90), anastomotic leak (OR = 1.23, 95% CI: 0.67 to 2.27, P = 0.50), anastomotic bleeding (OR = 0.87, 95% CI: 0.28 to 2.67, P = 0.80), postoperative pulmonary infection (OR = 0.94, 95% CI: 0.34 to 2.57, P = 0.90), and mortality (OR = 1.33, 95% CI: 0.27 to 6.48, P = 0.72).
Overlap esophagojejunostomy is a safe and effective procedure during totally laparoscopic total gastrectomy. It is superior to other types of anastomosis in reducing anastomotic stenosis rates.
全腹腔镜胃癌根治术仅限于少数专家外科医生，其原因之一是腹腔镜下进行食管空肠吻合术的技术难度。近年来，重叠吻合术作为一种更受欢迎的重建方法；然而，其临床结果尚无定论。因此，本荟萃分析旨在提供更高水平的证据，证明全腹腔镜全胃切除术中重叠吻合术的安全性和有效性。
检索 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，截至 2021 年 11 月，以回顾性研究、前瞻性研究和重叠吻合与其他吻合比较的随机对照试验的英文文献。提取纳入文章的基本信息和观察指标。同一研究人员使用 Cochrane 偏倚风险工具独立评估纳入的随机对照试验的偏倚风险，并使用 Newcastle-Ottawa 量表评估队列研究的质量。使用 Review Manager 5.3 生成森林图进行荟萃分析，使用漏斗图评估发表偏倚，并进行敏感性分析以评估结果稳定性。
共有 12 项研究的 1534 名患者纳入本研究（重叠组 738 例，非重叠组 796 例）。纳入指标的荟萃分析显示，与其他吻合方法相比，重叠吻合术的吻合口狭窄发生率较低（OR=0.19，95%置信区间 [CI]：0.09 至 0.41，P<0.0001），两组均有显著差异。然而，两组之间的手术时间（WMD=13.79，95%CI：-5.41 至 32.98，P=0.16）、吻合时间（WMD=7.18，95%CI：-5.34 至 19.69，P=0.26）、术中出血量（WMD=19.96，95%CI：-17.80 至 57.72，P=0.30）、淋巴结检出数（WMD=-1.33，95%CI：-6.24 至 3.57，P=0.59）、首次排气时间（WMD=-0.11，95%CI：-0.25 至 0.04，P=0.14）、术后住院时间（WMD=-0.09，95%CI：-1.59 至 1.41，P=0.90）、吻合口漏（OR=1.23，95%CI：0.67 至 2.27，P=0.50）、吻合口出血（OR=0.87，95%CI：0.28 至 2.67，P=0.80）、术后肺部感染（OR=0.94，95%CI：0.34 至 2.57，P=0.90）和死亡率（OR=1.33，95%CI：0.27 至 6.48，P=0.72）无显著差异。
重叠吻合术在全腹腔镜全胃切除术中是一种安全有效的术式。与其他类型的吻合术相比，它可降低吻合口狭窄的发生率。
