Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3093-3099
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3093
Outcomes for jejunal interposition reconstruction compared with Roux-en-Y anastomosis: A meta-analysis
Kai-Xi Fan, Zhong-Fa Xu, Mei-Rong Wang, Dao-Tang Li, Xiang-Shan Yang, Jing Guo
Kai-Xi Fan, Central Laboratory, Third Department of Medicine, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan 250031, Shandong Province, China
Zhong-Fa Xu, Dao-Tang Li, Department of General Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan 250031, Shandong Province, China
Mei-Rong Wang, School of Dentistry and Oral Health, Shandong Yingcai University, Jinan 250104, Shandong Province, China
Xiang-Shan Yang, Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan 250031, Shandong Province, China
Jing Guo, School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan 250031, Shandong Province, China
Author contributions: Fan KX and Xu ZF contributed to this work equally; Fan KX and Xu ZF conceived the study, participated in the design, collected the data, performed statistical analyses, and drafted the manuscript; Wang MR, Li DT, Yang XS and Gou J conceived the study, participated in the design, and helped to draft the manuscript; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kai-Xi Fan, MD, Central Laboratory, Third Department of Medicine, Affiliated Hospital of Shandong Academy of Medical Sciences, No. 38, Wuyingshan Road, Jinan 250031, Shandong Province, China. fankkxx@126.com
Telephone: +86-531-61368632 Fax: +86-531-61368631
Received: May 4, 2014
Peer-review started: May 4, 2014
First decision: June 10, 2014
Revised: July 21, 2014
Accepted: November 8, 2014
Article in press: November 11, 2014
Published online: March 14, 2015
Processing time: 318 Days and 17.1 Hours
Abstract

AIM: To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.

METHODS: A systematic literature search was conducted by two independent researchers on PubMed, EMBASE, the Cochrane Library, Google Scholar, and other English literature databases, as well as the Chinese Academic Journal, Chinese Biomedical Literature Database, and other Chinese literature databases using “Gastrostomy”, “Roux-en-Y”, and “Interposition” as keywords. Data extraction and verification were performed on the literature included in this study. RevMan 5.2 software was used for data processing. A fixed-effects model was applied in the absence of heterogeneity between studies. A random effects model was applied in the presence of heterogeneity between studies.

RESULTS: Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study. Among them, 357 received jejunal interposition reconstruction after total gastrostomy, and 405 received Roux-en-Y anastomosis. Compared with Roux-en-Y anastomosis, jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome (OR = 0.18, 95%CI: 0.10-0.31; P < 0.001), increased the prognostic nutritional index [weighted mean difference (WMD) = 6.02, 95%CI: 1.82-10.22; P < 0.001], and improved the degree of postoperative weight loss [WMD = 2.47, 95%CI: -3.19-(-1.75); P < 0.001]. However, there is no statistically significant difference in operative time, hospital stay, or incidence of reflux esophagitis.

CONCLUSION: Compared with Roux-en-Y anastomosis, patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improved life quality.

Keywords: Gastric cancer; Total gastrostomy; Jejunal interposition reconstruction; Roux-en-Y anastomosis; Meta-analysis; Digestive tract reconstruction

Core tip: This study compared the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer through systematic review and meta-analysis. We found compared with Roux-en-Y anastomosis, jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome, increased the prognostic nutritional index, and improved the degree of postoperative weight loss. However, there is no statistically significant difference in operative time, hospital stay, or incidence of reflux esophagitis. Therefore, we conclude that patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improved life quality.