Liu Cheng-Cong, Yang Jian, Yin Gang, Tian Zhen, Qin Chen
Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, Shandong Province, China.
Department of General Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, Shandong Province, China.
World J Gastrointest Surg. 2025 Aug 27;17(8):107706. doi: 10.4240/wjgs.v17.i8.107706.
Proximal gastrectomy (PG) for gastric cancer requires a delicate balance between oncological radicality and postoperative quality of life to mitigate reflux complications. Although the Kamikawa anastomosis has gained attention for its theoretical anti-reflux advantages, robust clinical evidence remains limited.
To comprehensively evaluate the efficacy, safety, and nutritional outcomes of the Kamikawa anastomosis in PG, thereby addressing a critical gap in surgical decision-making.
Following PRISMA guidelines, we systematically searched PubMed, Embase, and the Cochrane Library for studies on Kamikawa anastomosis after PG. Data were pooled using fixed- or random-effects models based on heterogeneity levels ( statistics). The risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions. The protocol was prospectively registered in PROSPERO.
Of 106 screened studies, 20 involving 2291 patients were included. Most studies (85%) originated from Japan, with a mean patient age of 54-73 years and a male predominance (68.1%). Overall pooled incidence of 30-day postoperative complications was 9.9% [95% confidence interval (95%CI): 6.8-12.9], with major complications (Clavien-Dindo grade ≥ III) occurring in 6.1% (95%CI: 4.6-7.7). Anastomosis-related complications were observed in 7.2% of cases, comprising leakage 1.8% (95%CI: 1.1-2.4), stenosis in 7.2% (95%CI: 5.8-8.5), and bleeding in 0.7% (95%CI: 0.1-1.2). Pooled incidence of reflux esophagitis was 4% (95%CI: 2.7-5.3) for all LA grades at 12-month follow-up, with 28.3% (95%CI: 14.7-41.9) of patients requiring regular proton pump inhibitor use. Operative outcomes demonstrated a pooled mean operative time of 349.5 minutes (95%CI: 331-380), estimated blood loss of 351.5 mL (95%CI: 264-495), and postoperative hospital stay of 12.3 days (95%CI: 11.5-13.1). Nutritional outcomes revealed 11.4% (95%CI: 10.6-12.2) body weight loss at one year. Comparative analyses showed equivalent safety profiles between the Kamikawa anastomosis and double-tract reconstruction but longer operative times ( < 0.001) compared with total gastrectomy.
These findings underscore the clinical viability of the Kamikawa anastomosis following PG, demonstrating favorable anti-reflux efficacy, acceptable incidence of anastomotic strictures, and preservation of nutritional status.
胃癌近端胃切除术（PG）需要在肿瘤根治性和术后生活质量之间取得微妙平衡，以减轻反流并发症。尽管上川吻合术因其理论上的抗反流优势而受到关注，但其有力的临床证据仍然有限。
全面评估上川吻合术在近端胃切除术中的疗效、安全性和营养结局，从而填补手术决策中的关键空白。
按照PRISMA指南，我们系统检索了PubMed、Embase和Cochrane图书馆，以查找近端胃切除术后上川吻合术的研究。根据异质性水平（统计学）使用固定效应或随机效应模型汇总数据。使用干预性非随机研究中的偏倚风险评估偏倚风险。该方案已在PROSPERO中进行前瞻性注册。
在筛选的106项研究中，纳入了20项涉及2291例患者的研究。大多数研究（85%）来自日本，患者平均年龄为54至73岁，男性占优势（68.1%）。术后30天并发症的总体汇总发生率为9.9%[95%置信区间（95%CI）：6.8-12.9]，主要并发症（Clavien-Dindo分级≥Ⅲ级）发生率为6.1%（95%CI：4.6-7.7）。7.2%的病例观察到吻合口相关并发症，包括渗漏1.8%（95%CI：1.1-2.4）、狭窄7.2%（95%CI：5.8-8.5）和出血0.7%（95%CI：0.1-1.2）。在12个月随访时，所有洛杉矶分级的反流性食管炎汇总发生率为4%（95%CI：2.7-5.3），28.3%（95%CI：14.7-41.9）的患者需要定期使用质子泵抑制剂。手术结局显示汇总平均手术时间为349.5分钟（95%CI：331-380），估计失血量为351.5毫升（95%CI：264-495），术后住院时间为12.3天（95%CI：11.5-13.1）。营养结局显示1年后体重减轻11.4%（95%CI：10.6-12.2）。比较分析显示，上川吻合术和双通道重建之间的安全性相当，但与全胃切除术相比手术时间更长（P<0.001）。
这些发现强调了近端胃切除术后上川吻合术的临床可行性，显示出良好的抗反流疗效、可接受的吻合口狭窄发生率以及营养状况的保留。
