Abstract：
BACKGROUND: Increased survival of patients undergoing total gastrectomy for gastric cancer has prompted several efforts to improve long-term postgastrectomy syndrome (PGS) outcomes. Whether a J-pouch (JP) reconstruction may be more beneficial than a standard Roux-en-Y (RY) is controversial.
METHODS: A systematic review with meta-analysis was conducted, including studies reporting long-term outcomes of patients treated with total gastrectomy and JP vs RY esophagojejunostomy for gastric adenocarcinoma. A literature search was performed on PubMed, Scopus, and Google Scholar. Primary endpoints were symptom control, weight loss, eating capacity (EC), and quality of life (QoL) with at least 6 months of follow-up. Safety endpoints were explored.
RESULTS: Overall, 892 patients were included from 15 studies (6 randomized controlled trials [RCTs] and 9 non-RCTs): 452 (50.7%) in the JP group and 440 (49.3%) in the RY group. Compared with RY, JP showed a significantly lower rate of dumping syndrome (13.8% vs 26.9%, odds ratio [OR], 0.29; 95% confidence interval [CI], 0.14-0.58; P < .001; I2 = 22%) and heartburn symptoms (20.4% vs 39.0%; OR, 0.29; 95% CI, 0.14-0.64; P = .002; I2 = 0%). Reflux (OR, 0.61; 95% CI, 0.28-1.32; P = .21; I2 = 42%) and epigastric fullness (OR, 0.60; 95% CI, 0.18-2.05; P = .41; I2 = 69%) were similar in both groups. Weight loss and EC were similar between the groups. QoL outcome seemed to be burdened by bias. There was no difference in morbidity, mortality, and anastomotic leak rate between groups. Operative time was significantly longer for JP than for RY (271.9 vs 251.6 minutes, respectively; mean difference, 21.55; 95% CI, 4.64-38.47; P = .01; I2 = 96%).
CONCLUSIONS: JP reconstruction after total gastrectomy for gastric cancer is as safe as RY and may provide an advantage in postgastrectomy dumping syndrome and heartburn symptoms.
METHODS: A systematic review with meta-analysis was conducted, including studies reporting long-term outcomes of patients treated with total gastrectomy and JP vs RY esophagojejunostomy for gastric adenocarcinoma. A literature search was performed on PubMed, Scopus, and Google Scholar. Primary endpoints were symptom control, weight loss, eating capacity (EC), and quality of life (QoL) with at least 6 months of follow-up. Safety endpoints were explored.
RESULTS: Overall, 892 patients were included from 15 studies (6 randomized controlled trials [RCTs] and 9 non-RCTs): 452 (50.7%) in the JP group and 440 (49.3%) in the RY group. Compared with RY, JP showed a significantly lower rate of dumping syndrome (13.8% vs 26.9%, odds ratio [OR], 0.29; 95% confidence interval [CI], 0.14-0.58; P < .001; I2 = 22%) and heartburn symptoms (20.4% vs 39.0%; OR, 0.29; 95% CI, 0.14-0.64; P = .002; I2 = 0%). Reflux (OR, 0.61; 95% CI, 0.28-1.32; P = .21; I2 = 42%) and epigastric fullness (OR, 0.60; 95% CI, 0.18-2.05; P = .41; I2 = 69%) were similar in both groups. Weight loss and EC were similar between the groups. QoL outcome seemed to be burdened by bias. There was no difference in morbidity, mortality, and anastomotic leak rate between groups. Operative time was significantly longer for JP than for RY (271.9 vs 251.6 minutes, respectively; mean difference, 21.55; 95% CI, 4.64-38.47; P = .01; I2 = 96%).
CONCLUSIONS: JP reconstruction after total gastrectomy for gastric cancer is as safe as RY and may provide an advantage in postgastrectomy dumping syndrome and heartburn symptoms.
摘要：
背景：胃癌全胃切除术后患者生存率的提高促使人们做出一些努力来改善长期胃切除术后综合征（PGS）的结局。J袋（JP）重建是否比标准Roux-en-Y（RY）更有益是有争议的。
方法：进行了荟萃分析的系统评价，包括报告全胃切除术和JP与RY食管空肠吻合术治疗胃腺癌患者的长期结局的研究。在PubMed上进行了文献检索，Scopus,谷歌学者。主要终点是症状控制，减肥,进食能力(EC)，和生活质量（QoL），随访至少6个月。探讨了安全性终点。
结果：总体而言，从15项研究（6项随机对照试验[RCTs]和9项非RCTs）中纳入892例患者：JP组452例（50.7%），RY组440例（49.3%）。与RY相比,JP显示倾倒综合征的发生率明显较低(13.8%对26.9%，赔率比[OR]，0.29；95%置信区间[CI]，0.14-0.58；P<.001；I2=22％）和胃灼热症状（20.4％vs39.0％；OR，0.29；95%CI，0.14-0.64；P=.002；I2=0%）。回流(OR,0.61；95%CI，0.28-1.32；P=.21；I2=42%）和上腹部饱满度（OR，0.60；95%CI，0.18-2.05；P=.41；I2=69%）两组相似。两组之间的体重减轻和EC相似。QoL结果似乎受到偏见的影响。发病率没有差异，死亡率,组间吻合口漏率。JP的手术时间明显长于RY（271.9vs251.6分钟，分别是；平均差，21.55；95%CI，4.64-38.47；P=0.01；I2=96%）。
结论：胃癌全胃切除术后的JP重建与RY一样安全，可能在胃切除术后倾倒综合征和胃灼热症状方面具有优势。
方法：进行了荟萃分析的系统评价，包括报告全胃切除术和JP与RY食管空肠吻合术治疗胃腺癌患者的长期结局的研究。在PubMed上进行了文献检索，Scopus,谷歌学者。主要终点是症状控制，减肥,进食能力(EC)，和生活质量（QoL），随访至少6个月。探讨了安全性终点。
结果：总体而言，从15项研究（6项随机对照试验[RCTs]和9项非RCTs）中纳入892例患者：JP组452例（50.7%），RY组440例（49.3%）。与RY相比,JP显示倾倒综合征的发生率明显较低(13.8%对26.9%，赔率比[OR]，0.29；95%置信区间[CI]，0.14-0.58；P<.001；I2=22％）和胃灼热症状（20.4％vs39.0％；OR，0.29；95%CI，0.14-0.64；P=.002；I2=0%）。回流(OR,0.61；95%CI，0.28-1.32；P=.21；I2=42%）和上腹部饱满度（OR，0.60；95%CI，0.18-2.05；P=.41；I2=69%）两组相似。两组之间的体重减轻和EC相似。QoL结果似乎受到偏见的影响。发病率没有差异，死亡率,组间吻合口漏率。JP的手术时间明显长于RY（271.9vs251.6分钟，分别是；平均差，21.55；95%CI，4.64-38.47；P=0.01；I2=96%）。
结论：胃癌全胃切除术后的JP重建与RY一样安全，可能在胃切除术后倾倒综合征和胃灼热症状方面具有优势。
