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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).
CONCLUSIONS: 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.
BACKGROUND: This meta-analysis was registered on the PROSPERO (CRD42022381357).
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).
CONCLUSIONS: 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.
BACKGROUND: This meta-analysis was registered on the PROSPERO (CRD42022381357).
摘要：
背景：近端胃切除术后的最佳重建方法尚不清楚。本系统评价和荟萃分析旨在比较各种重建方法的短期结果和长期生活质量。
方法：PubMed，Embase,搜索了WebofScience和Cochrane图书馆，以确定有关近端胃切除术后重建方法的比较研究。将重建方法分为六组:双束重建(DTR)、食管胃造口术（EG），胃管重建（GT），空肠间置术（JI），空肠囊间置术（JPI）和双皮瓣技术（DFT）。食管胃吻合术组(EG组)包括EG,GT和DFT，食管空肠吻合术组（EJ组）包括DTR，JI和JPI。
结果：本荟萃分析共纳入27项研究，共2410例患者。汇总结果表明，DTR的反流性食管炎的发生率，EG,GT,JI,JPI和DFT为7.6%，27.3%,4.5%,7.1%,14.0%,和9.1%，分别。EG组反流性食管炎(OR=3.68,95CI2.44~5.57,P<0.00001)和吻合口狭窄(OR=1.58,95CI1.02~2.45,P=0.04)均高于EJ组。但EG组手术时间较短(MD=-56.34,95CI-76.75--35.94,P<0.00001),术中出血量较少(MD=-126.52,95CI-187.91--65.12,P<0.0001),术后住院时间较短(MD=-2.07,95CI-3.66-0.48,P=0.01).同时,EG组术后并发症较少(OR=0.68,95CI0.51-0.90,P=0.006),体重减轻较少(MD=-1.25,95CI-2.11--0.39,P=0.004).对于特定的重建方法，与食管胃吻合术相比，DTR的反流性食管炎（OR=0.10，95CI0.06-0.18，P<0.00001）和吻合口狭窄（OR=0.14，95CI0.06-0.33，P<0.00001）较少。DTR和食管胃吻合术在吻合口漏方面差异无统计学意义(OR=1.01,95CI0.34～3.01,P=0.98)。
结论：近端胃切除术后食管空肠吻合术可降低反流性食管炎和吻合口狭窄的发生率。而食管胃吻合术在技术简单和长期体重状态方面具有优势。双道重建术是一种安全的技术，具有出色的抗反流效果和良好的生活质量。
背景：该荟萃分析已在PROSPERO（CRD42022381357）上注册。
方法：PubMed，Embase,搜索了WebofScience和Cochrane图书馆，以确定有关近端胃切除术后重建方法的比较研究。将重建方法分为六组:双束重建(DTR)、食管胃造口术（EG），胃管重建（GT），空肠间置术（JI），空肠囊间置术（JPI）和双皮瓣技术（DFT）。食管胃吻合术组(EG组)包括EG,GT和DFT，食管空肠吻合术组（EJ组）包括DTR，JI和JPI。
结果：本荟萃分析共纳入27项研究，共2410例患者。汇总结果表明，DTR的反流性食管炎的发生率，EG,GT,JI,JPI和DFT为7.6%，27.3%,4.5%,7.1%,14.0%,和9.1%，分别。EG组反流性食管炎(OR=3.68,95CI2.44~5.57,P<0.00001)和吻合口狭窄(OR=1.58,95CI1.02~2.45,P=0.04)均高于EJ组。但EG组手术时间较短(MD=-56.34,95CI-76.75--35.94,P<0.00001),术中出血量较少(MD=-126.52,95CI-187.91--65.12,P<0.0001),术后住院时间较短(MD=-2.07,95CI-3.66-0.48,P=0.01).同时,EG组术后并发症较少(OR=0.68,95CI0.51-0.90,P=0.006),体重减轻较少(MD=-1.25,95CI-2.11--0.39,P=0.004).对于特定的重建方法，与食管胃吻合术相比，DTR的反流性食管炎（OR=0.10，95CI0.06-0.18，P<0.00001）和吻合口狭窄（OR=0.14，95CI0.06-0.33，P<0.00001）较少。DTR和食管胃吻合术在吻合口漏方面差异无统计学意义(OR=1.01,95CI0.34～3.01,P=0.98)。
结论：近端胃切除术后食管空肠吻合术可降低反流性食管炎和吻合口狭窄的发生率。而食管胃吻合术在技术简单和长期体重状态方面具有优势。双道重建术是一种安全的技术，具有出色的抗反流效果和良好的生活质量。
背景：该荟萃分析已在PROSPERO（CRD42022381357）上注册。
