A Meta-Analysis Of Double-Channel Jejunal Interposition And Direct Esophagogastric Anastomosis For Gastrointestinal Reconstruction After Radical Resection Of Proximal Gastric Cancer

ObjectiveBy comparing between the double-channel jejunum to the proximal stomach cancer radical surgery technique(DJI)and direct anastomosis of esophagus stomach(EG)of the two patients with digestive tract reconstruction after intraoperative and postoperative clinical indicators related to further explore the research of this two kinds of digestive tract reconstruction way will affect the choice of the surgical results and the incidence of postoperative complications,respectively considering their scientific,validity and rationality,and then to choose the reasonable digestive tract reconstruction in the proximal stomach cancer radical surgery way to provide a clinical reference.MethodsLiterature retrieval was conducted in Pubmed,Embase,Web of Science,Cochrane Library,wanfang and other databases to select relevant literatures that were compared with double-channel jejunal interposition(DJI)and esophagogastric direct anastomosis(EG)for digestive tract reconstruction after proximal radical gastrectomy.The retrieval time was from the establishment of the database to the end of December2019.Weighted mean differences in combined odds ratios or 95% confidence intervals were calculated using fixed or random effects models to compare differences in surgical clinical indicators,such as operative time,intraoperative blood loss,and postoperative complications(such as anastomotic fistula,reflux gastritis,and delayed gastric emptying),P<0.05 was considered statistically significant.ResultsIn this study,a total of 5 non-randomized observational clinical studies(OCS)were selected,including 153 patients undergoing double-channel jejunostomy(DJI)and 199 patients undergoing direct esophagogastric anastomosis(EG),respectively.The results of meta-analysis showed that compared with EG group,the operation time of DJI group was prolonged(WMD=45.11;95% CI =(40.70,49.53);P<0.00001 intraoperative blood loss(WMD=15.55;95% CI =(11.82,19.28);P<0.00001),but the incidence of postoperative complications(WMD=0.43;95% CI =(0.26,0.71);P=0.0009)is better than EG group.ConclusionAfter radical gastrectomy of proximal gastric cancer,double-channel jejunal interposition(DJI)is used as the method of digestive tract reconstruction.Although the operation time is prolonged to some extent and the intraoperative blood loss is increased,it is a better choice because it can bring a lower incidence of postoperative complications.