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Year : 2018  |  Volume : 131  |  Issue : 6  |  Page : 713-720

Comparison of Intracorporeal and Extracorporeal Esophagojejunostomy after Laparoscopic Total Gastrectomy for Gastric Cancer: A Meta-Analysis Based on Short-Term Outcomes

Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 300106, China

Correspondence Address:
Dr. Xiu-Jun Cai
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 300106, Zhejiang
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0366-6999.226899

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Background: Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG. Methods: Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3. Results: Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: −13.52 ml; 95% CI: −24.82–−2.22; P = 0.02), earlier time to first oral intake (WMD: −0.49 day; 95% CI: −0.83–−0.14; P < 0.01), and shorter length of hospitalization (WMD: −0.62 day; 95% CI: −1.08–−0.16; P < 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P > 0.05). Conclusions: Compared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.


 Abstract in Chinese



背景: 腹腔镜全胃切除术在胃癌治疗中应用日益增加。然而, 腹腔镜全胃切除术后采用腹腔内食管空肠吻合术却很有限, 因其安全性和疗效尚不明确。本篇荟萃分析旨在评估腹腔镜全胃切除术后采用腹腔内食管空肠吻合术的可行性和安全性。

方法: 在PubMed、EBSCO、Cochrane Library、Embase、中国知网数据库中查阅从1994年1月至2017年1月发表的腹腔镜全胃切除术行腹腔内和腹腔外食管空肠吻合术的对比研究。比较并分析两组手术结果, 术后恢复, 和术后并发症情况。用Review Manager 5.3软件计算加权平均差(WMD)和比值比(OR)以它们的95%置信区间(CI)。

结果: 7篇非随机研究文献纳入研究,共包含785名患者。相比于腹腔外食管空肠吻合术,腹腔内食管空肠吻合术术中出血更少(WMD: −13.52 ml; 95 % CI: −24.82 - −2.22; P = 0.02),术后进食时间更早(WMD: −0.49 day; 95 % CI: −0.83 - −0.14; P <0.01),住院时间更短(WMD: −0.62 day; 95 % CI: −1.08 - −0.16; P <0.01)。在手术时间、吻合时间、淋巴结切除数目、术后排气、吻合口漏、吻合口狭窄和近端切缘这些指标上,两组间无明显差异(P>0.05)。

结论: 与腹腔外食管空肠吻合术相比,腹腔内食管空肠吻合术具有更好的美观性,更轻的手术创伤,更快术后恢复等优势,同时可以做到一样安全。因此,应该鼓励具有足够手术经验的外科医生尝试腹腔内食管空肠吻合。

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