Zhu Junjie, Tan Fei, Xu Kai, Xing Jiadi, Su Xiangqian
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Beijing, 100142, China.
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Beijing, 100142, China.
Updates Surg. 2025 Aug 6. doi: 10.1007/s13304-025-02300-3.
Reflux esophagitis (RE) is an important complication after proximal gastrectomy (PG) among proximal gastric cancer (PGC) patients. In recent years, different digestive reconstruction methods have been used to reduce the risk of RE.
To present and synthesize the clinical trial evidence regarding the postoperative RE associated with different digestive tract reconstruction methods following PG in patients with PGC.
We conducted an electronic literature search on PubMed, Web of Science (WOS), and Embase from the time of establishment of the database to February 14, 2025. Two independent reviewers screened studies that adhered to inclusion and exclusion criteria. The main outcome was the incidence of postoperative RE after PG among PG patients, which was analyzed by network meta-analysis with a consistency model. Newcastle-Ottawa Scale (NOS) and Cochrane Collaboration's tool were used to assess the risk of bias in the included studies. Heterogeneity and inconsistency analysis to evaluate the robustness of the results.
30 studies involving 2,411 PGC patients were included in the analysis. The average incidence rates were as follows: DFT: 0.04, JI: 0.06, DTR: 0.08, JPI: 0.12, GT: 0.14, and EG: 0.24. DFT was associated with a lower risk of postoperative RE compared to EG (0.08 [0.02-0.27]). DTR also showed a lower risk of postoperative RE compared to EG (0.18 [0.10-0.36]). Conversely, EG had a higher risk of postoperative RE compared to JI (4.83 [2.33-10.06]). Possible rankings for reducing the incidence of RE were as follows: DFT > DTR>JI > JPI > GT > EG. Inconsistencies were noted between DTR and EG. However, the direct, indirect, and consistent effects all exhibited the same directional trend. Heterogeneity was identified in comparisons between EG vs GT and GT vs DFT (I > 50%).
DFT, DTR, and JI had a significantly lower risk of postoperative RE compared with EG. To prevent postoperative RE, DFT was the best, DTR second best.
反流性食管炎（RE）是近端胃癌（PGC）患者近端胃切除术后（PG）的重要并发症。近年来，人们采用了不同的消化道重建方法来降低RE的风险。
呈现并综合关于PGC患者PG术后不同消化道重建方法相关术后RE的临床试验证据。
我们从数据库建立至2025年2月14日在PubMed、科学网（WOS）和Embase上进行了电子文献检索。两名独立评审员筛选符合纳入和排除标准的研究。主要结局是PGC患者PG术后RE的发生率，采用一致性模型通过网络荟萃分析进行分析。使用纽卡斯尔-渥太华量表（NOS）和Cochrane协作网工具评估纳入研究的偏倚风险。进行异质性和不一致性分析以评估结果的稳健性。
分析纳入了30项涉及2411例PGC患者的研究。平均发生率如下：双通道空肠间置术（DFT）：0.04，间置空肠代胃术（JI）：0.06，十二指肠残端Roux-en-Y吻合术（DTR）：0.08，间置空肠袋代胃术（JPI）：0.12，全胃切除术（GT）：0.14，食管胃吻合术（EG）：0.24。与EG相比，DFT术后RE风险较低（0.08 [0.02 - 0.27]）。与EG相比，DTR术后RE风险也较低（0.18 [0.10 - 0.36]）。相反，与JI相比，EG术后RE风险较高（4.83 [2.33 - 10.06]）。降低RE发生率的可能排序如下：DFT > DTR > JI > JPI > GT > EG。DTR与EG之间存在不一致性。然而，直接、间接和一致性效应均呈现相同的方向趋势。在EG与GT以及GT与DFT的比较中发现了异质性（I² > 50%）。
与EG相比，DFT、DTR和JI术后RE风险显著较低。为预防术后RE，DFT最佳，DTR次之。
