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
Research background

Gastric cancer is the fourth most common cancer worldwide and the third most frequent cause of death from cancer. At present, the choice of gastrointestinal reconstruction after distal gastrectomy (DG) for gastric cancer remains controversial. Uncut Roux-en-Y (U-RY) reconstruction is an improvement of the Roux-en-Y (RY) reconstruction, which is a promising method that may replace the previous type of anastomosis. This systematic review and meta-analysis aimed to compare the clinical efficacy and safety of U-RY vs RY reconstruction after DG for gastric cancer.

Research motivation

A method of digestive tract reconstruction called “U-RY anastomosis” was first proposed in 1988. It has been a research hotspot for years since then. Some surgeons consider U-RY reconstruction superior to RY reconstruction, while others do not. Therefore, its use remains controversial.

Research objectives

This novel meta-analysis compared U-RY and RY reconstruction after DG for gastric cancer. It compared U-RY and RY reconstruction in terms of perioperative outcomes, postoperative complications, and postoperative nutritional status.

Research methods

A literature search was conducted to identify studies comparing U-RY with RY after DG for gastric cancer. Using either fixed- or random-effects models, pooled odds ratios or weighted mean difference with 95% confidence interval was calculated. Meta-analyses were performed using RevMan 5.3 software.

Research results

Some clinical advantages were provided by U-RY reconstruction, such as shorter operative time and lowered incidence of reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome.

Research conclusions

The present study showed that U-RY reconstruction after DG for gastric cancer was secure and feasible, providing a guideline for clinical practice. However, high-quality RCTs in multiple centers are still needed for further confirmation.

Research perspectives

U-RY anastomosis maintained mesenteric continuity and ensured good perfusion of the anastomotic site. It could reduce the formation of anastomotic stenosis.