Comparison Between Esophagogastrostomy And Jejunal Interposition Reconstruction After Proximal Gastrectomy For Gastric Cancer:A Meta-Analysis

Objective:By comparing the efficacy and safety of esophagogastrostomy(EG)and jejunal interposition(JI)reconstruction after proximal gastrectomy,to explore the suitable way of digestive tract reconstruction after radical operation of proximal gastric cancer.Methods:A literature search was conducted in PubMed,Embase,Cochrane Library,Chinese National Knowledge Infrastructure,Wanfang and China Science and Technology Journal Database to identify studies comparing JI reconstruction with EG after proximal gastrectomy for gastric cancer the deadline is June 30,2019.Pooled odds ratio(OR)or weighted mean difference(WMD)with 95% confidence interval(95%CI)was calculated using either fixed-or random-effects models.Perioperative outcomes including length of surgery,intraoperative blood loss,and postoperative hospital stay;postoperative complications including anastomotic fistula,anastomotic stricture,intestinal obstruction,reflux symptoms/esophagitis and 5-year survival rate were the main outcomes evaluated.Meta-analyses of observation indicators were performed using Review Manager 5.3 software.Results:Twelve studies met the inclusion criteria,that 12 observational clinical studies were 464 and 317 patients in the EG and JI groups,respectively.Meta analysis showed that compared with JI reconstruction,the operation time of EG group was significantly shorter(WMD: 53.71;95% CI:45.14 to 62.27;P<0.00001),intraoperative bleeding(WMD: 46.67;95% CI: 21.70 to 71.65;P = 0.0002),postoperative intestinal obstruction rate(OR: 4.11;95% CI: 1.23 to 13.70;P = 0.02),postoperative hospitalization days(WMD: 4.53;95% CI: 0.40 to 8.66;P = 0.03)were significantly reduced.The results suggested that JI reconstruction had significantly lower incidence of reflux symptoms/esophagitis(OR: 0.40;95%CI: 0.25 to 0.64;p= 0.0001)compared to EG reconstruction.There was no significant difference between the two groups in anastomotic fistula(OR:2.12;95%CI:0.56 to 8.05;P=0.27),anastomotic stricture(OR:0.84;95%CI:0.46 to 1.56;P=0.59),5-year survival rate(OR:1.25;95%CI:0.59 to 2.64;P =0.56).Conclusion: 1.EG reconstruction has the advantages of simple operation and high safety,but the incidence of reflux symptoms/esophagitis in this reconstruction method is relatively high,which has obvious disadvantages compared with JI reconstruction.2.JI reconstruction can significantly reduce the incidence of reflux symptoms/esophagitis,and is a better way to reconstruct the digestive tract after resection of most proximal gastric cancer,which is worthy of clinical application.