Meta-Analysis Of Comparison Between Uncut Roux-en-Y And Roux-en-Y Reconstruction After Distal Gastrectomy For Gastric Cancer

Objective: To compare the intraoperative and postoperative clinical parameters of patients with distal gastric cancer who were after radical resection of Uncut Roux-en-Y(U-RY)and Billroth II(B-II),then we explored two digestive tract reconstructions whose relationship between the perioperative outcome and postoperative nutritional status to provide a evidence for the choice of digestive tract reconstruction after radical gastrectomy.Methods: A literature was searched in Pubmed,Embase,Web of Science,Cochrane Library,Wanfang and other databases to screen for distal gastric cancer after radical surgery by using Uncut Roux-en-Y(U-RY)and Billroth II(B-II)radical resection.The patients after the reconstruction were divided into the U-RY group and the B-II group.The retrieval time was from the end of December to the end of December 2018.Using the fixed or random effects model to calculate the combined odds ratio or the weighted mean difference of the 95% confidence interval,and compared perioperative clinical indicators such as the operation time,intraoperative bleeding quantity,postoperative hospital stay,and postoperative complications(such as anastomotic leak,reflux gastritis,gastric retention)and postoperative nutritional status(the levels of serum hemoglobin,total protein and albumin),P<0.05 was considered to be statistically significant.Results: After screening,a total of 2 randomized controlled trials and 8non-randomized clinical trials were performed,involving 525 patients in the U-RY group and 551 patients in the B-II group.Compared with the B-II group,the meta-analysis showed that the postoperative hospital stay was significantly shorter in the U-RY group(WMD=-0.87;95% CI(-1.31,0.43);P<0.05).The operation time(WMD:3.81;95% CI:-0.69~8.31;P=0.10)and intraoperative bleeding quantity of the two groups(WMD:-1.43;95% CI:-5.07~2.20;P=0.44)were showed no significant difference(P>0.05).Compared with the B-II group,The incidence of the bile reflux(OR:0.07;95% CI:0.04~0.14;P<0.05),reflux gastritis(OR:0.15;95% CI: 0.10)~0.22;P<0.05)and gastric retention(OR:0.40;95% CI: 0.21~0.75;P<0.05)in the U-RY group was significantly lower;Compared with the B-II group,There was no significant difference in the incidence of duodenal stump fistula(OR: 0.47;95% CI: 0.13 to1.66;P = 0.24)and anastomotic leak(OR:0.67;95% CI: 0.21 to 2.14;P= 0.50).Compared with the B-II group,there was no significant difference on the total protein(WMD:0.03;95% CI:-0.69~0.75;P=0.97)and the serum albumin(WMD:0.08;95% CI:-0.44~0.60;P=0.76))in the postoperative nutritional status.There was no significant difference in serum hemoglobin(WMD:-0.60;95% CI:-1.74~0.54;P=0.30)(P>0.05).Conclusion: Uncut Roux-en-Y digestive tract reconstruction has the advantages of short postoperative hospital stay and low the incidence of bile reflux,reflux gastritis and gastric retention,and it is worthy of application.