Proximal Gastrectomy With Double-tract And Total Gastrectomy With Roux-en-Y In The Treatment Of Early Proximal Gastric Cancer: A Meta-analysis

Objective:A meta-analysis was used to explore the short-and medium-term effects of the double-tract reconstruction after early proximal gastrectomy(PG-DT)and the classic total gastrectomy with esophagojejunostomy(Roux-en-Y)gastrointestinal reconstruc-tion surgery after early proximal gastrectomy.So as to provide a better surgical method for the reconstruction of the digestive tract after early proximal gastrectomy..Methods:Search Pub Med,Embase,The Cochrane Library,Wanfang Database,CNKI and China Biomedical Literature and other databases respectively to collect early proximal gastric cancer undergoing total gastrectomy with esophageal jejunal anast-omosis and proximal gastrectomy with double-tract reconstruction.The literature of jejunal surgery is deleted from the unqualified and repeated literature,and the obtained literature is screened according to the predefined inclusion and exclusion criteria.Preoperative general indicators(gender,age,BMI,etc.),intraoperative blood loss,duration of surgery,length of postoperative hospital stay,related complications,and nutritional status one year after surgery were assessed in the two groups.Using Rev Man5.3 for meta-analysis,relevant conclusions were drawn after comprehensive comparative analysis.Results:A total of 23 studies were included in the meta-analysis,of which 22 were retrospective studies and one was prospective study.A total of 1817 patients were enrolled,including 822 in the PG-DT group and 995 in the RY group.The two groups of data were collected for comparative study and analysis,and the results were as follows:There were statistically significant differences in postoperative reflux esophagitis(OR=0.36,95%CI= 0.23-0.55,P < 0.0001),postoperative dumping syndrome(OR=0.24,95%CI= 0.12-0.48,P < 0.0001),postoperative complications of postpranational fulgancy(WMD=0.11,95%CI= 0.02-0.55,P=0.007),postoperative abdominal infection(OR=0.94,95%CI= 0.50-1.76,P=0.84),anastomotic leakage(OR=1.11,95%CI= 0.62-2.01,P=0.72),anastomotic stenosis(OR=1.07,95%CI=0.51--2.28,P=0.86),postoperative intestinal obstruction(OR=0.59,95%CI=0.27--1.33,P=0.21),operative time(WMD=6.35,95%CI=-5.21--17.91,P=0.28),intraoperative blood loss(WMD=-9.57,95%CI=-31.42--12.28,P=0.39)there was no significant difference in postoperative anal first discharge time(WMD=-0.25,95%CI=-0.44 ～-0.07,P=0.006),postoperative hospital stay(WMD=-0.99,95%CI=-1.77 ～-0.20,P=0.01),postoperative lymph node acquisition number(WMD=-5.32,95%CI=-7.69～-2.95,P < 0.05),serum albumin and hemoglobin content one year after surgery(WMD=2.63,95%CI=1.55～3.71,P<0.05;WMD=4.93,95%CI= 2.05-7.81,P=0.00080),but there was no statistically significant difference in total complications between PG-DT group and RY group(OR=0.85,95%CI= 0.64-1.13,P=0.27).Conclusions:The findings of the current study indicated that:(1)Compared with the RY group,the PG-DT group had more clinical significance in postoperative hospital stay,first postoperative anal ventilation time,reflux esophagus,dumping syndrome and postoperative complications of postpranal fullness after proximal gastrectomy;(2)There were no statistically significant differences between the two groups in the contents of serum albumin and hemoglobin and the incidence of total complications one year after surgery,and there was no significant difference between PG-DT and RY.