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. 2019 Jan 24;10(4):789-798.
doi: 10.7150/jca.28843. eCollection 2019.

The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy: A Systemic Review and Meta-Analysis

Xi-Jie Chen  1   2 , Yun-Zhi Chen  3 , Dong-Wen Chen  1   2 , Ying-Liang Chen  1   2 , Jun Xiang  1   2 , Yi-Jia Lin  1   2 , Shi Chen  1   2 , Jun-Sheng Peng  1   2
Affiliations

The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy: A Systemic Review and Meta-Analysis

Xi-Jie Chen et al. J Cancer. .

Abstract

Background: Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y are common reconstruction techniques of distal gastrectomy. Which of these techniques is better has yet to be established. We performed an indirect comparison to evaluate which technique was optimal for preventing reflux symptoms. Methods: The PubMed, Cochrane Collaboration, Embase, ClinicalTrials.gov and Web of Science databases were searched to identify clinical trials that compared at least two of the reconstruction skills among Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y. Data on reflux gastritis, intraoperative blood loss, bile reflux and postoperative hospital stays were extracted from the included clinical trials for meta-analysis using a random-effects model. Results: Twenty-four articles that included 5419 individuals were assessed as eligible for meta-analysis. The indirect comparison suggested that Roux-en-Y reconstruction significantly reduces reflux gastritis, and it tended to rank first and had the highest probability of preventing bile reflux. No significant differences were found in intraoperative blood loss and postoperative hospital stays. Conclusion: This indirect comparison suggested some superiority of Roux-en-Y reconstruction after distal gastrectomy. Further perspective clinical trials are required to provide evidence for the optimal reconstruction skill.

Keywords: distal gastrectomy; indirect comparison; meta-analysis; net-work meta-analysis; reconstruction.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow chart of articles screening.
Figure 2
Figure 2
Network of indirect comparisons. The size of the nodes stands for the number of patients included and line width the number of articles comparing each pair of treatments.
Figure 3
Figure 3
Risk of bias graph and risk of bias summary of RCTs
Figure 4
Figure 4
Ranking of outcomes for the included studies. Odds ratio(OR) and 95% confidence interval(CI) were used to expressed the difference between reconstructions. First rank indicates lowest probability to prevent occurrence of reflux gastritis and bile reflux. For intraoperative blood loss, first rank indicates highest probability of more blood loss. For post-operative hospital stay, first rank indicates highest probability of hospitalization.
See this image and copyright information in PMC

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