Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
ULS São João, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Sci Rep. 2024 Oct 8;14(1):23477. doi: 10.1038/s41598-024-72456-2.
Gastric Cancer (GC) is the fifth most common cancer worldwide. Early stages of GC began being detected, giving rise to a new concern, Quality of Life. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HBP), and body mass index (BMI) reduction rate and to provide an overview of recent research on oncometabolic surgery (OS). We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y reconstruction, and residual stomach on T2DM, HBP, and BMI reduction rate. Heterogeneity was assessed using the I statistics. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95% CI) [1.27; 1.62]) and 1.3 (95% CI [1.00; 1.69]), respectively. Compared with the Billroth II group, Roux-en-Y reconstruction had significantly greater T2DM remission after gastrectomy (RR = 1.19; 95% CI [1.08; 1.31]), while HBP showed no significant differences. Regarding the improvement of HBP, total gastrectomy was significantly superior to subtotal gastrectomy (95% CI [1.01; 2.64]). A trend towards Roux-en-Y Esophagojejunostomy as the best option for T2DM remission was observed (95% CI [0.98; 2.77]; p = 0.06). Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Further research is needed to assess the impact of OS on metabolic diseases.
胃癌（GC）是全球第五大常见癌症。随着早期 GC 的发现，一个新的关注点出现了，即生活质量。本研究旨在系统评估不同 GC 重建技术对术后 2 型糖尿病（T2DM）、高血压（HBP）和体重指数（BMI）降低率的影响，并提供关于代谢肿瘤手术（OS）的最新研究综述。我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，通过搜索三个数据库进行了系统评价和荟萃分析。我们进行了荟萃分析风险比和均数差，以评估十二指肠旁路、Roux-en-Y 重建和残胃对 T2DM、HBP 和 BMI 降低率的影响。使用 I ²统计量评估异质性。在随访结束时，与 Billroth I 相比，十二指肠旁路组术后 T2DM 和 HBP 的缓解率显著更高，相对风险（RR）分别为 1.43（95%置信区间（95%CI）[1.27；1.62]）和 1.3（95%CI [1.00；1.69]）。与 Billroth II 组相比，Roux-en-Y 重建术后 T2DM 缓解更为显著（RR=1.19；95%CI [1.08；1.31]），而 HBP 无显著差异。关于 HBP 的改善，全胃切除术明显优于胃大部切除术（95%CI [1.01；2.64]）。观察到 Roux-en-Y 空肠食管吻合术作为 T2DM 缓解最佳选择的趋势（95%CI [0.98；2.77]；p=0.06）。Roux-en-Y 重建胃切除术似乎是 T2DM 缓解的最有效治疗方法。需要进一步研究来评估 OS 对代谢性疾病的影响。
