胃切除术后 Roux-en-Y 吻合术与或不与空肠 J 袢重建用于胃癌：长期功能结局的系统评价和荟萃分析。

Roux-en-Y with or without jejunal J-pouch reconstruction after total gastrectomy for gastric cancer: systematic review and meta-analysis of long-term functional outcomes.

机构信息

Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy; University of Milan, Milan, Italy.

Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy.

出版信息

J Gastrointest Surg. 2024 Mar;28(3):291-300. doi: 10.1016/j.gassur.2023.12.015. Epub 2024 Jan 19.

DOI:10.1016/j.gassur.2023.12.015

PMID:38445924

Abstract

BACKGROUND

Increased survival of patients undergoing total gastrectomy for gastric cancer has prompted several efforts to improve long-term postgastrectomy syndrome (PGS) outcomes. Whether a J-pouch (JP) reconstruction may be more beneficial than a standard Roux-en-Y (RY) is controversial.

METHODS

A systematic review with meta-analysis was conducted, including studies reporting long-term outcomes of patients treated with total gastrectomy and JP vs RY esophagojejunostomy for gastric adenocarcinoma. A literature search was performed on PubMed, Scopus, and Google Scholar. Primary endpoints were symptom control, weight loss, eating capacity (EC), and quality of life (QoL) with at least 6 months of follow-up. Safety endpoints were explored.

RESULTS

Overall, 892 patients were included from 15 studies (6 randomized controlled trials [RCTs] and 9 non-RCTs): 452 (50.7%) in the JP group and 440 (49.3%) in the RY group. Compared with RY, JP showed a significantly lower rate of dumping syndrome (13.8% vs 26.9%, odds ratio [OR], 0.29; 95% confidence interval [CI], 0.14-0.58; P < .001; I = 22%) and heartburn symptoms (20.4% vs 39.0%; OR, 0.29; 95% CI, 0.14-0.64; P = .002; I = 0%). Reflux (OR, 0.61; 95% CI, 0.28-1.32; P = .21; I = 42%) and epigastric fullness (OR, 0.60; 95% CI, 0.18-2.05; P = .41; I = 69%) were similar in both groups. Weight loss and EC were similar between the groups. QoL outcome seemed to be burdened by bias. There was no difference in morbidity, mortality, and anastomotic leak rate between groups. Operative time was significantly longer for JP than for RY (271.9 vs 251.6 minutes, respectively; mean difference, 21.55; 95% CI, 4.64-38.47; P = .01; I = 96%).

CONCLUSION

JP reconstruction after total gastrectomy for gastric cancer is as safe as RY and may provide an advantage in postgastrectomy dumping syndrome and heartburn symptoms.

摘要

背景

接受全胃切除术治疗胃癌的患者的生存率提高，促使人们努力改善长期胃切除术后综合征（PGS）的结局。空肠袢（JP）重建是否比标准 Roux-en-Y（RY）更有益尚存争议。

方法

对报道了接受全胃切除术和 JP 与 RY 食管空肠吻合术治疗胃腺癌的患者的长期结局的研究进行了系统评价和荟萃分析。在 PubMed、Scopus 和 Google Scholar 上进行了文献检索。主要终点是至少 6 个月随访时的症状控制、体重减轻、进食能力（EC）和生活质量（QoL）。还探讨了安全性终点。

结果

共有 15 项研究（6 项随机对照试验和 9 项非随机对照试验）纳入了 892 例患者：JP 组 452 例（50.7%），RY 组 440 例（49.3%）。与 RY 相比，JP 术后倾倒综合征（13.8% vs 26.9%，比值比[OR]，0.29；95%置信区间[CI]，0.14-0.58；P<0.001；I = 22%）和烧心症状（20.4% vs 39.0%；OR，0.29；95% CI，0.14-0.64；P=0.002；I = 0%）的发生率显著更低。反流（OR，0.61；95% CI，0.28-1.32；P=0.21；I = 42%）和上腹部饱胀（OR，0.60；95% CI，0.18-2.05；P=0.41；I = 69%）在两组间相似。两组间体重减轻和 EC 相似。QoL 结局似乎存在偏倚。两组间发病率、死亡率和吻合口漏发生率无差异。JP 的手术时间明显长于 RY（分别为 271.9 分钟和 251.6 分钟；平均差值，21.55；95% CI，4.64-38.47；P=0.01；I = 96%）。