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BMC Cancer
Published in: BMC Cancer 1/2024

Open Access 01-12-2024 | Gastrectomy | Research

Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis

Authors: Bailong Li, Yinkui Wang, Baocong Li, Fei Shan, Ziyu Li

Published in: BMC Cancer | Issue 1/2024

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Abstract

Background

The optimal reconstruction method after proximal gastrectomy remains unclear. This systematic review and meta-analysis aimed to compare the short-term outcomes and long-term quality of life of various reconstruction methods.

Methods

PubMed, Embase, Web of Science and Cochrane Library were searched to identify comparative studies concerning the reconstruction methods after proximal gastrectomy. The reconstruction methods were classified into six groups: double tract reconstruction (DTR), esophagogastrostomy (EG), gastric tube reconstruction (GT), jejunal interposition (JI), jejunal pouch interposition (JPI) and double flap technique (DFT). Esophagogastric anastomosis group (EG group) included EG, GT and DFT, while esophagojejunal anastomosis group (EJ group) included DTR, JI and JPI.

Results

A total of 27 studies with 2410 patients were included in this meta-analysis. The pooled results indicated that the incidences of reflux esophagitis of DTR, EG, GT, JI, JPI and DFT were 7.6%, 27.3%, 4.5%, 7.1%, 14.0%, and 9.1%, respectively. The EG group had more reflux esophagitis (OR = 3.68, 95%CI 2.44–5.57, P < 0.00001) and anastomotic stricture (OR = 1.58, 95%CI 1.02–2.45, P = 0.04) than the EJ group. But the EG group showed shorter operation time (MD=-56.34, 95%CI -76.75- -35.94, P < 0.00001), lesser intraoperative blood loss (MD=-126.52, 95%CI -187.91- -65.12, P < 0.0001) and shorter postoperative hospital stay (MD=-2.07, 95%CI -3.66- -0.48, P = 0.01). Meanwhile, the EG group had fewer postoperative complications (OR = 0.68, 95%CI 0.51–0.90, P = 0.006) and lesser weight loss (MD=-1.25, 95%CI -2.11- -0.39, P = 0.004). For specific reconstruction methods, there were lesser reflux esophagitis (OR = 0.10, 95%CI 0.06–0.18, P < 0.00001) and anastomotic stricture (OR = 0.14, 95%CI 0.06–0.33, P < 0.00001) in DTR than the esophagogastrostomy. DTR and esophagogastrostomy showed no significant difference in anastomotic leakage (OR = 1.01, 95%CI 0.34–3.01, P = 0.98).

Conclusion

Esophagojejunal anastomosis after proximal gastrectomy can reduce the incidences of reflux esophagitis and anastomotic stricture, while esophagogastric anastomosis has advantages in technical simplicity and long-term weight status. Double tract reconstruction is a safe technique with excellent anti-reflux effectiveness and favorable quality of life.

Registration

This meta-analysis was registered on the PROSPERO (CRD42022381357).
Appendix
Available only for authorised users
Literature
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. Cancer J Clin. 2021;71(3):209–49.CrossRef
2.
Ahn HS, Lee H-J, Yoo M-W, Jeong S-H, Park D-J, Kim H-H, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg. 2010;98(2):255–60.CrossRef
3.
Liu K, Yang K, Zhang W, Chen X, Chen X, Zhang B, et al. Changes of Esophagogastric Junctional Adenocarcinoma and Gastroesophageal Reflux Disease among Surgical patients during 1988–2012: a Single-institution, high-volume experience in China. Ann Surg. 2016;263(1):88–95.CrossRefPubMed
4.
Japanese Gastric Cancer Treatment Guidelines. 2021 (6th edition). Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2023;26(1):1–25.
5.
Li S, Gu L, Shen Z, Mao D, Khadaroo PA, Su H. A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer. BMC Surg. 2019;19(1):117.CrossRefPubMedPubMedCentral
6.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedCentral
7.
Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–80.CrossRefPubMedPubMedCentral
8.
Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, et al. Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2002;5(2):83–9.CrossRefPubMed
9.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
10.
Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JPT et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database of Systematic Reviews. 2019(10).
11.
12.
Aburatani T, Kojima K, Otsuki S, Murase H, Okuno K, Gokita K, et al. Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD. Surg Endosc. 2017;31(11):4848–56.CrossRefPubMed
13.
Adachi Y, Inoue T, Hagino Y, Shiraishi N, Shimoda K, Kitano S. Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction. Gastric cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 1999;2(1):40–5.CrossRefPubMed
14.
Chen X-F, Zhang B, Chen Z-X, Hu J-K, Dai B, Wang F, et al. Gastric Tube Reconstruction reduces postoperative gastroesophageal reflux in Adenocarcinoma of Esophagogastric Junction. Dig Dis Sci. 2012;57(3):738–45.CrossRefPubMed
15.
Eom BW, Park JY, Park KB, Yoon HM, Kwon OK, Ryu KW et al. Comparison of nutrition and quality of life of esophagogastrostomy and the double-tract reconstruction after laparoscopic proximal gastrectomy. Medicine. 2021;100(15).
16.
Hu L, Zhang R, Sun X. Long-term quality-of-life comparison between three reconstruction methods after gastrectomy in patients with stage I proximal gastric cancer. Chin J Gen Surg. 2021;36(12):905–9.
17.
Ichikawa D, Ueshima Y, Shirono K, Kan K, Shioaki Y, Lee CJ, et al. Esophagogastrostomy reconstruction after limited proximal gastrectomy. Hepatogastroenterology. 2001;48(42):1797–801.PubMed
18.
Isobe T, Hashimoto K, Kizaki J, Matono S, Murakami N, Kinugasa T, et al. Reconstruction methods and complications in proximal gastrectomy for gastric cancer, and a comparison with total gastrectomy. Kurume Med J. 2014;61(1–2):23–9.CrossRefPubMed
19.
Ji X, Jin C, Ji K, Zhang J, Wu X, Jia Z et al. Double Tract Reconstruction Reduces Reflux Esophagitis and improves quality of Life after Radical Proximal Gastrectomy for patients with Upper gastric or Esophagogastric Adenocarcinoma. Cancer Res Treatment: Official J Korean Cancer Association. 2020.
20.
Kumamoto T, Sasako M, Ishida Y, Kurahashi Y, Shinohara H. Clinical outcomes of proximal gastrectomy for gastric cancer: a comparison between the double-flap technique and jejunal interposition. PLoS ONE. 2021;16(2):e0247636.CrossRefPubMedPubMedCentral
21.
Li LH, Ma L, Xiao YL, Mao WZ, Li Y. [Reconstructive approaches of alimentary canal for subtotal gastrectomy]. Zhonghua Yi Xue Za Zhi. 2011;91(14):961–4.PubMed
22.
Li Z, Dong J, Huang Q, Zhang W, Tao K. Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study. World J Surg Oncol. 2019;17(1):209.CrossRefPubMedPubMedCentral
23.
Masuzawa T, Takiguchi S, Hirao M, Imamura H, Kimura Y, Fujita J, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg. 2014;38(5):1100–6.CrossRefPubMed
24.
Miyauchi W, Matsunaga T, Shishido Y, Miyatani K, Hanaki T, Kihara K, et al. Comparisons of postoperative complications and nutritional Status after Proximal Laparoscopic Gastrectomy with Esophagogastrostomy and double-Tract Reconstruction. Yonago Acta Medica. 2020;63(4):335–42.CrossRefPubMedPubMedCentral
25.
Nakamura M, Nakamori M, Ojima T, Katsuda M, Iida T, Hayata K, et al. Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: an analysis of our 13-year experience. Surgery. 2014;156(1):57–63.CrossRefPubMed
26.
Nomura E, Kayano H, Lee S-W, Kawai M, Machida T, Yamamoto S, et al. Functional evaluations comparing the double-tract method and the jejunal interposition method following laparoscopic proximal gastrectomy for gastric cancer: an investigation including laparoscopic total gastrectomy. Surg Today. 2019;49(1):38–48.CrossRefPubMed
27.
Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Moriya H, et al. Clinical experience of laparoscopy-assisted proximal gastrectomy with Toupet-like partial fundoplication in early gastric cancer for preventing reflux esophagitis. J Am Coll Surg. 2009;209(3):344–51.CrossRefPubMed
28.
Seshimo A, Miyake K, Amano K, Aratake K, Kameoka S. Clinical outcome of esophagogastrotomy after proximal gastrectomy for gastric cancer. Hepatogastroenterology. 2013;60(123):616–9.PubMed
29.
Shiraishi N, Adachi Y, Kitano S, Kakisako K, Inomata M, Yasuda K. Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg. 2002;26(9):1150–4.CrossRefPubMed
30.
Takagawa R, Kunisaki C, Kimura J, Makino H, Kosaka T, Ono HA, et al. A pilot study comparing jejunal pouch and jejunal interposition reconstruction after proximal gastrectomy. Dig Surg. 2010;27(6):502–8.CrossRefPubMed
31.
Tokunaga M, Ohyama S, Hiki N, Hoshino E, Nunobe S, Fukunaga T, et al. Endoscopic evaluation of reflux esophagitis after proximal gastrectomy: comparison between esophagogastric anastomosis and jejunal interposition. World J Surg. 2008;32(7):1473–7.CrossRefPubMed
32.
Toyomasu Y, Ogata K, Suzuki M, Yanoma T, Kimura A, Kogure N, et al. Restoration of gastrointestinal motility ameliorates nutritional deficiencies and body weight loss of patients who undergo laparoscopy-assisted proximal gastrectomy. Surg Endosc. 2017;31(3):1393–401.CrossRefPubMed
33.
Wang X, Wang B, Liu N, Ding X, Zhang R, Liang H. Clinical efficacy of radical proximal gastrectomy with esophagogastrostomy and double-tract anastomosis for upper gastric cancer. Chin J Dig Surg. 2021;20(6):689–94.
34.
Yasuda A, Yasuda T, Imamoto H, Kato H, Nishiki K, Iwama M, et al. A newly modified esophagogastrostomy with a reliable angle of his by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy. Gastric cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2015;18(4):850–8.CrossRefPubMed
35.
Zeng C, Huang L, Chen L, Huang H, Zheng Y, Chi L. [Comparison of short- and long-term efficacy of three procedures in postoperative digestive tract reconstruction for upper gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi = Chinese. J Gastrointest Surg. 2014;17(5):444–8.
36.
Zhang B, Ji S-q, Hua Y-w, Liu Y-q. Application of jejunal interposition after radical proximal gastrectomy. Zhonghua Zhong Liu Za Zhi. [Chinese J Oncology]. 2013;35(7):530–3.
37.
Zhang Z-d, Ma F, Zhang Y-l, Ma E-m, Kong Y, Liu H-x, et al. Comparison study of three methods of digestive tract reconstruction after radical gastrectomy in gastric cancer patients. Zhonghua Wei Chang Wai Ke Za Zhi = Chinese Journal of Gastrointestinal Surgery. 2013;16(11):1073–7.PubMed
38.
Zhao Q, Li Y, Yang P, Tan B, Fan L, Jiao Z et al. Application of modified double tracks anastomosis in patients with Siewert II-III adenocarcinoma of the esophagogastric junction treated with radical gastrectomy. Zhonghua Wei Chang Wai Ke Za Zhi [Chinese journal of gastrointestinal surgery]. 2015;18(5):437–41.
39.
Yoo CH, Sohn BH, Han WK, Pae WK. Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach. Cancer Res Treat. 2004;36(1):50–5.CrossRefPubMedPubMedCentral
40.
Park DJ, Han SU, Hyung WJ, Hwang SH, Hur H, Yang HK, et al. Effect of laparoscopic proximal gastrectomy with double-Tract Reconstruction vs total gastrectomy on hemoglobin level and vitamin B12 supplementation in Upper-Third Early gastric Cancer: a Randomized Clinical Trial. JAMA Netw open. 2023;6(2):e2256004.CrossRefPubMedPubMedCentral
41.
Yamashita Y, Yamamoto A, Tamamori Y, Yoshii M, Nishiguchi Y. Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy. Gastric cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2017;20(4):728–35.CrossRefPubMed
42.
Park SH, Khalayleh H, Kim SG, Eom SS, Merei F, Ryu J et al. Spade-shaped anastomosis after laparoscopic proximal gastrectomy using double suture anchoring between the posterior wall of the Esophagus and the Anterior Wall of the stomach (SPADE Operation): a Case Series. Cancers (Basel). 2022;14(2).
43.
Shaibu Z, Chen Z, Mzee SAS, Theophilus A, Danbala IA. Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis. World J Surg Oncol. 2020;18(1):171.CrossRefPubMedPubMedCentral
44.
Shoji Y, Nunobe S, Ida S, Kumagai K, Ohashi M, Sano T, et al. Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer. Gastric cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 2019;22(5):1036–43.CrossRefPubMed
Metadata
Title
Short-term outcomes and long-term quality of life of reconstruction methods after proximal gastrectomy: a systematic review and meta-analysis
Authors
Bailong Li
Yinkui Wang
Baocong Li
Fei Shan
Ziyu Li
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-024-11827-4

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