Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2018; 24(24): 2628-2639
Published online Jun 28, 2018. doi: 10.3748/wjg.v24.i24.2628
Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis
Ming-Ming Sun, Yi-Yi Fan, Sheng-Chun Dang
Ming-Ming Sun, Yi-Yi Fan, Sheng-Chun Dang, Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
Author contributions: Sun MM and Fan YY reviewed and screened the articles included in our meta-analysis; Sun MM and Dang SC performed the analysis and drafted the manuscript; Fan YY and Dang SC drew the essential diagrams; Sun MM and Dang SC designed the study and edited the manuscript.
Supported by Jiangsu Province Fund Projects for “Six Talent Peaks” High-Level Talent, No. 2016-WSN-007.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data is available.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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:
Correspondence to: Sheng-Chun Dang, MD, Professor, Chief Doctor, Surgeon, Department of General Surgery, the Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang 212001, Jiangsu Province, China.
Telephone: +86-511-88820988 Fax: +86-511-88820988
Received: March 13, 2018
Peer-review started: March 13, 2018
First decision: March 30, 2018
Revised: April 5, 2018
Accepted: June 2, 2018
Article in press: June 2, 2018
Published online: June 28, 2018

To compare uncut Roux-en-Y (U-RY) gastrojejunostomy with Roux-en-Y (RY) gastrojejunostomy after distal gastrectomy (DG) for gastric cancer.


A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed- or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status (serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Meta-analyses were performed using RevMan 5.3 software.


Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference (WMD): -12.95; 95%CI: -22.29 to -3.61; P = 0.007] and incidence of reflux gastritis/esophagitis (OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying (OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome (OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin (WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein.


U-RY reconstruction has some clinical advantages over RY reconstruction after DG.

Keywords: Roux-en-Y, Gastric cancer, Meta-analysis, Distal gastrectomy, Reconstruction, Uncut

Core tip: No consensus was available in the literature about gastrointestinal reconstruction after distal gastrectomy (DG) for distal gastric cancer. The present study was a novel systematic review and meta-analysis comparing uncut Roux-en-Y (U-RY) and Roux-en-Y (RY) reconstruction after DG for gastric cancer. This study investigated the relationship between the two in terms of perioperative outcomes, postoperative complications, and postoperative nutritional status. U-RY reconstruction was found to have some advantages, such as less operative time, less postoperative complications, and better postoperative nutritional status, over the conventional RY.