Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis

To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth I (B-I) anastomosis after distal gastrectomy (DG) for gastric cancer. A literature search was performed to identify studies comparing R-Y with B-I after DG for gastric cancer from January 1990 to Nov...

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Vydáno v:World journal of gastroenterology : WJG Ročník 19; číslo 7; s. 1124
Hlavní autoři: Xiong, Jun-Jie, Altaf, Kiran, Javed, Muhammad A, Nunes, Quentin M, Huang, Wei, Mai, Gang, Tan, Chun-Lu, Mukherjee, Rajarshi, Sutton, Robert, Hu, Wei-Ming, Liu, Xu-Bao
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 21.02.2013
Témata:
Anastomosis, Roux-en-Y - adverse effects
Anastomosis, Roux-en-Y - mortality
Chi-Square Distribution
Gastrectomy - adverse effects
Gastrectomy - mortality
Gastroenterostomy - adverse effects
Gastroenterostomy - mortality
Humans
Odds Ratio
Plastic Surgery Procedures - adverse effects
Plastic Surgery Procedures - mortality
Postoperative Complications - etiology
Risk Factors
Stomach Neoplasms - surgery
Time Factors
Treatment Outcome
Reconstruction
Billroth I
Roux-en-Y
Gastric cancer
Distal gastrectomy
Meta-analysis
ISSN:2219-2840, 2219-2840
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Popis
Shrnutí:To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth I (B-I) anastomosis after distal gastrectomy (DG) for gastric cancer. A literature search was performed to identify studies comparing R-Y with B-I after DG for gastric cancer from January 1990 to November 2012 in Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either fixed or random effects model. Operative outcomes such as operation time, intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture, bile reflux, remnant gastritis, reflux esophagitis, dumping symptoms, delayed gastric emptying and hospital stay were the main outcomes assessed. Meta-analyses were performed using RevMan 5.0 software (Cochrane library). Four randomized controlled trials (RCTs) and 9 non-randomized observational clinical studies (OCS) involving 478 and 1402 patients respectively were included. Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reflux (OR 0.04, 95%CI: 0.01, 0.14; P < 0.00 001) and remnant gastritis (OR 0.43, 95%CI: 0.28, 0.66; P = 0.0001), however needing a longer operation time (WMD 40.02, 95%CI: 13.93, 66.11; P = 0.003). Meta-analysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reflux (OR 0.21, 95%CI: 0.08, 0.54; P = 0.001), remnant gastritis (OR 0.18, 95%CI: 0.11, 0.29; P < 0.00 001) and reflux esophagitis (OR 0.48, 95%CI: 0.26, 0.89; P = 0.02). However, this reconstruction method was found to be associated with a longer operation time (WMD 31.30, 95%CI: 12.99, 49.60; P = 0.0008). This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-I reconstruction post DG. However there is a need for further adequately powered, well-designed RCTs comparing the same.
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ISSN:2219-2840
2219-2840
DOI:10.3748/wjg.v19.i7.1124