Comparison of proximal gastrectomy with different gastrointestinal reconstruction for esophagogastric junction adenocarcinoma: a network Meta-analysis

Abstract

Objective To systematically evaluate the prognostic efficacy of various gastrointestinal reconstruction modalities after esophagogastric union cancer resection. Methods The literature comparing the three gastrointestinal reconstruction modalities of esophageal remnant gastric anastomosis (EG), esophageal jejunal Roux-en-Y anastomosis and dual channel anastomosis (DTR) published from January 2016 to May 2022 were collected by searching domestic and foreign databases, and the literature was screened and extracted by the researcher before performing a network Meta-analysis. Results Thirty-four literatures with a total of 2 876 patients were included in the study. Meta-analysis results showed that DTR performed best in terms of postoperative complication rates such as prevention of reflux esophagitis, intestinal obstruction and anastomotic leakage, and in terms of albumin, haemoglobin and total protein levels at 6 months postoperatively(P<0.05). Conclusion Of the three gastrointestinal reconstruction modalities, DTR has a good anti-reflux effect and can effectively prevent various post-operative complications, and the patient has good post-operative nutrition, a rapid recovery and a good prognosis for the immediate future of the procedure.

Keywords

• gastric cancer
• gastrointestinal reconstruction
• esophagogastric junction adenocarcinoma
• esophagogastro-stomy
• oesophagojejunostomy roux-en-y anastomosis
• double-tract reconstruction
• network meta-analysis