Meta Analysis Of The Safety And Quality Of Postoperative Life Of Billroth Ⅰ,Ⅱ And Roux-en-Y Anastomosis In Laparoscopic Radical Gastrectomy

Objective With the continuous maturation of laparoscopic technology,in recent years,it has become more and more widely used in surgical treatment of gastric cancer,which has largely replaced the traditional open surgery.Since advanced gastric cancer is the main type of gastric cancer in China,Laparoscopic radical gastrectomy(LDG)is still the most commonly performed gastric cancer surgery[1],and the main anastomosis methods are:Billroth Ⅰ(B1),Billroth Ⅱ(B2)and Roux-en-Y(RY).At present,the literature and guidelines have not reached an absolute consensus on these three anastomosis methods.The purpose of this study is to explore the laparoscopic approaches for the reconstruction of various gastrointestinal tracts for radical gastric cancer radical surgery.Safety and prognosis,determine the most suitable anastomosis.Methods A computer search of Pubmed,Google Scholar,Cochrane Library Center,and Web of science literature library was used to select and compare Billroth Ⅰ,Billroth Ⅱ,and Roux-en-Y anastomosis of laparoscopic radical gastric cancer radical surgery.The publication period was within 10 years,inclusion criteria was set to conduct this systematic review and meta-analysis.Result A total of 23 research articles(21 retrospective studies and 2 randomized controlled trials)related to inclusion criteria were retrieved,of which 3 articles were compared for Billroth Ⅰ and Billroth Ⅱ anastomosis,and there are 3 documents compareing Billroth Ⅱ and Roux-en-Y anastomosis,14 documents comparing Billroth Ⅰ and Roux-en-Y anastomosis,and 3 documents including 3 reconstructions.The total number of patient samples involved was 6,502,including 3634 in the B1 group,1382 in the B2 group,and 1483 in the RY group.Compared with group B2,there was no significant difference in the intraoperative blood loss(P=0.68)and the length of hospital stay(P=0.19),First exhaust(P=0.75),first meal(P=0.11),postoperative reconstruction-related complications(P=0.83),gastric retention(P=0.49),and residual gastritis(P=0.65)in group B1.The number of lymphadenectomy in group B2 was lesser than that in group B1(P=0.004),the operation time in group B1 was significantly less than that in group B2(P<0.00001),the total postoperative complications in group B1 was less than that in group B2(P=0.0005),and the bile reflux in group B1 was less than that in group B2(P<0.00001).Comparing the group B1 and the group RY,it was found that the intraoperative blood loss(P=0.11),the time of first meal(P=0.61),and the length of hospital stay(P=0.54),Postoperative reconstruction-related complications(P=0.46),total postoperative complications(P=0.44),gastric retention(P=0.42)were not statistically significant,and the number of lymph node dissections during operation was lesser in group B1 than in group RY.(P=0.0006),the B1 group was significantly better than the RY group in terms of operation time(P<0.00001),and the B1 group was better than the RY group in terms of first exhaust time(P=0.003).In endoscopic related symptoms(residual gastritis,bile reflux,and reflux esophagitis),the RY group was significantly superior to the B1 group(P<0.00001,P=0.002,P<0.00001).Compared with RY group,B2 group had no significant difference in operation time(P=0.10),intraoperative bleeding volume(P=0.86),hospitalization time(P=0.16),average time of the first exhaust(P=0.51),time of the first diet(P=1.00),total postoperative complications(P=0.46)and reconstruction-related complications(P=0.86).RY group was significantly better than B2 group in terms of lymph node dissection quantity(P<0.0001).However,in the postoperative endoscopic symptoms(residual gastritis,bile reflux and reflux esophagitis),RY group was significantly superior to B2 group(P=0.003,P=0.01,P=0.003).Conlusion The three anastomosis methods have no obvious statistical significance in comparison of most indicators,and compared with B1 and B2,RY anastomosis has an advantage in anti-reflux effect after operation.When performing LDG digestive tract reconstruction,it is recommended to prefer the RY anastomosis method.This article has laid a reasonable foundation for guiding surgeons to choose the LDG digestive tract reconstruction method.