Meta Analysis Of Safety And Effectiveness Of Anastomosis Of Esophagus And Jejunum Overlap In Total Laparoscopic Total Gastrectomy

Objective:Systematically evaluate and compare the safety and effectiveness of esophagojejunostomy and traditional esophagojejunostomy in total laparoscopic total gastrectomy in the treatment of gastric cancer,providing evidence-based medical evidence for clinical practice.Methods:Pub Med,Embase,Cochrane Library,Web of Science,CNKI,Wanfang and VIP were searched by computer,and the retrieval time was up to March 2022.Relevant literatures were obtained,and eligible studies were gradually screened and included.Cochrane ROB bias risk assessment tool and NOS scale were used to evaluate the quality of the articles,and required data were extracted from high-quality literatures.Finally,meta-analysis was performed using Review Manager 5.4.1 software.Results:Finally,17 studies were included,including 1763 patients,including 799 patients who accept anastomosis and 964 patients who accept other anastomosis.The results showed that anastomosis overlap and other anastomosis in the operation time(MD=8.01,95%CI-0.91,16.92,P=0.08),intraoperative blood loss(MD=11.43,95%CI-5.24,28.10,P=0.18),postoperative first exhaust time(MD=-0.05,95% CI-0.17,0.06,P=0.42),time of first postoperative feeding(MD=0.08,95%CI-0.11,0.26,P=0.42),anastomotic leakage(OR=1.52,95%CI0.87,2.63,P=0.14),length of postoperative hospital stay(MD=-0.24,95% CI-0.71,0.23,P=0.32)and postoperative intestinal obstruction(OR=0.68,95%CI0.17,2.76,P=0.59)were not significantly different(all P > 0.05).Compared with other anastomosis,overlap anastomosis has longer anastomosis time(MD=7.77,95%CI4.28,11.26,P < 0.0001)and higher incidence of anastomotic bleeding(OR=2.45,95%CI1.11,5.43,P=0.03)and the incidence of anastomotic stenosis was low(OR=0.20,95%CI0.08,0.48,P=0.0004).Conclusion:Overlap esophagojejunostomy is a safe,effective and prognostic surgical method with high application value in total laparoscopic total gastrectomy.