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Meta-Analysis
. 2018 Jun 28;24(24):2628-2639.
doi: 10.3748/wjg.v24.i24.2628.

Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Ming-Ming Sun  1 , Yi-Yi Fan  1 , Sheng-Chun Dang  2
Affiliations
Meta-Analysis

Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Ming-Ming Sun et al. World J Gastroenterol. .

Abstract

Aim: To compare uncut Roux-en-Y (U-RY) gastrojejunostomy with Roux-en-Y (RY) gastrojejunostomy after distal gastrectomy (DG) for gastric cancer.

Methods: A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed- or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status (serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Meta-analyses were performed using RevMan 5.3 software.

Results: Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference (WMD): -12.95; 95%CI: -22.29 to -3.61; P = 0.007] and incidence of reflux gastritis/esophagitis (OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying (OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome (OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin (WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein.

Conclusion: U-RY reconstruction has some clinical advantages over RY reconstruction after DG.

Keywords: Distal gastrectomy; Gastric cancer; Meta-analysis; Reconstruction; Roux-en-Y; Uncut.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
Literature screening process. RCTs: Randomized controlled trials; OCS: Observational clinical studies.
Figure 2
Figure 2
Meta-analysis forest plots concerning operative time, intraoperative blood loss, and hospital stay.
Figure 3
Figure 3
Meta-analysis forest plots concerning anastomotic bleeding, anastomotic stricture, and anastomotic ulcer.
Figure 4
Figure 4
Meta-analysis forest plots concerning reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome.
Figure 5
Figure 5
Meta-analysis forest plots concerning serum hemoglobin, serum total protein, and serum albumin.
Figure 6
Figure 6
Subgroup analyses of observational clinical studies and randomized controlled trials.
Figure 7
Figure 7
Funnel plot of reflux gastritis/esophagitis rate in all included studies.
See this image and copyright information in PMC

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