Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Sun, Menghong; Fan, Yi-Yi; Dang, Sheng-Chun

doi:10.3748/wjg.v24.i24.2628

Cited by 29 publications

(19 citation statements)

References 32 publications

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“…Moreover, even if the postoperative complications of the Uncut Roux-Y group were similar to those of the Roux-Y group, Uncut Roux-Y anastomosis should still be the first choice due to its simplicity and costeffectiveness. Nevertheless, these data represent the results of six consecutive years at a specialized centre for gastric cancer surgery in a Chinese hospital, and at the very least, and these data support the previous studies in other centres that demonstrated the Uncut Roux-Y is an excellent method of anastomosis for distal gastrectomy, which is feasible as a laparoscopic surgery [23,24]. There are few limitations too, it is possible that the ligature was not effective and the closure failed at efferent loop of jejunum in Uncut Roux-Y patients.…”

Section: Discussionsupporting

confidence: 86%

Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y?

Sah

Yan

et al. 2020

BMC Surg

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Background: An appropriate method of anastomosis is crucial for gastric cancer patients who require gastrojejunal anastomosis. Surgeons have proposed different types of modified gastrojejunostomies in the last two decades. We focused on two types of standard anastomosis, i.e., Uncut Roux-Y and Roux-Y gastrojejunostomies, and compared the differences in immediate postoperative complications between the two types. Methods: This is a retrospective study on 236 gastric cancer patients who underwent curative distal gastrectomy with gastrojejunal Roux-Y or Uncut Roux-Y anastomosis for six consecutive years. Immediate postoperative complications were compared between the two groups. The authors discussed the causes of the significant complications and their management. Results: There was no difference in demographics between the two groups (92 Roux-y Versus 144 Uncut Roux-y). The overall complication rate was 20.8% with 1.4% anastomotic leakage in the Uncut Roux-Y group versus 33.7% with 7.6% anastomotic failures in the Roux-Y group (p < 0.05). More abdominal infections occurred in the Roux-Y anastomosis group compared with the Uncut Roux-Y anastomosis group (p < 0.05). Duration of postoperative stay was significantly longer in patients with Roux-y anastomosis group (p < 0.05). Conclusions: Considering the surgical simplicity and postoperative complications, the Uncut Roux-Y is a better choice for anastomosis in patients with gastric cancer undergoing gastrojejunostomy. A well-designed large cohort in a multi-centre randomized controlled trial is necessary to support these findings and compare other aspects.

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Section: Discussionsupporting

confidence: 86%

Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y?

Sah

Yan

et al. 2020

BMC Surg

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“…Roux-en-Y anastomosis requires two anastomoses, and thus increases the number of intestinal stumps, which requires rather complicated steps. Also, like Billroth II anastomosis, Roux-en-Y anastomosis does not highly conform to the human physiology and anatomy [8,12]…”

Section: Discussionmentioning

confidence: 99%

Application of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy

Zhang¹,

Zhang²,

yuan³

et al. 2020

Preprint

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Background Retrospectively register the clinical data of distal gastric cancer patients who received surgical treatment, discuss the safety and feasibility of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods Review the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, were accepted the totally laparoscopic distal gastrectomy. During the operation, the method of double needle-double layer continuous manual suture was used for Billroth I type anastomosis to complete digestive tract reconstruction. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General Information: Male (n = 27),Female(n = 14)༌Age(65.02 ± 9.94)years, BMI(23.52 ± 2.56)kg/m2; Tumor location: Antrum(32,78.0%), Angle (6,14.6%), Body (3,7.3%); Clinical stage: I (27,65.9%), II (7,17.1%), III (7,17.1%); Operative information: Operation time (154.51 ± 33.37)min, Anastomosis time (26.88 ± 5.11) min; Intraoperative bleeding (66.34 ± 48.81) ml; First postoperative ambulation (1.07 ± 0.26) d, First postoperative flatus(3.07 ± 1.08)d, First postoperative diet(3.41 ± 1.07)d༌Postoperative hospital stay(8.76 ± 6.64)d, Total hospitalization cost (70804.00 ± 14282.05)RMB yuan; Differentiation degree: High and high-moderate(3,7.32%), Moderate and poor-moderate (24,58.54%)༌Poor differentiation (14,34.15%); Dissected lymph node (32.76 ± 13.16), Positive lymph node (2.39 ± 4.06); Pathological stage: IA (20,48.78%), IB (3,7.32%), IIA (4,9.76%), IIB (5,12.20%), IIIA (1,2.44%), IIIB (3,7.32%), IIIC (5,12.20%); Complications(n = 4): Lung infection(1,2.44%)༌Anastomotic leakage (1,2.44%༉༌Gastroparesis (2,4.88%༉; Conclusion It is safe and feasible in clinical treatment to apply the method of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

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“…Two reviewers (CPW and JG) independently assessed the methodological quality of all included studies by using the Newcastle–Ottawa scale (NOS). [10,11] scale with a maximum of nine stars was adopted for the evaluation of the selection, comparability, exposure, and outcome of each study. Studies with a NOS scores of >7 were considered high-quality works.…”

Section: Methodsmentioning

confidence: 99%

Base excess in predicting the prognosis of patients with paraquat poisoning

et al. 2019

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Background: Although the prognostic significance of base excess (BE) in patients with paraquat (PQ) poisoning has been investigated for several years, the results remain controversial. Thus, we performed for the first time a comprehensive meta-analysis to explore the value of BE in predicting the prognosis of patients with PQ poisoning. Methods: We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and the Chinese National Knowledge Infrastructure to identify all relevant papers that were published up to August 2018. The data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and subgroup analysis. Results: Pooled analysis revealed that a decreased BE is correlated with poor mortality (pooled OR = 21.358, 95% CI: 12.716–35.873, P < .001). Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 78% (95% CI: 0.66–0.86), 88% (95% CI: 0.66–0.97), 6.6 (95% CI: 2.2–19.9), 0.25 (95% CI: 0.18–0.36), and 26 (10–69), respectively. No publication bias was detected by Egger test ( P = .263) and Begg test ( P = .462). Sensitivity analyses indicated no important differences among the estimates of effects. Conclusion: Our findings show that BE is useful for predicting the prognosis of PQ poisoning.

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Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Cited by 29 publications

References 32 publications

Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y?

Anastomosis for distal gastrectomy in Chinese patients: uncut roux-Y or roux-Y?

Application of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy

Base excess in predicting the prognosis of patients with paraquat poisoning

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