Meta-Analysis
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World J Gastroenterol. Feb 21, 2013; 19(7): 1124-1134
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1124
Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: A meta-analysis
Jun-Jie Xiong, Kiran Altaf, Muhammad A Javed, Quentin M Nunes, Wei Huang, Gang Mai, Chun-Lu Tan, Rajarshi Mukherjee, Robert Sutton, Wei-Ming Hu, Xu-Bao Liu
Jun-Jie Xiong, Gang Mai, Chun-Lu Tan, Wei-Ming Hu, Xu-Bao Liu, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Kiran Altaf, Muhammad A Javed, Quentin M Nunes, Wei Huang, Rajarshi Mukherjee, Robert Sutton, NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, Merseyside County, United Kingdom
Author contributions: Xiong JJ and Altaf K contributed equally to this work; Liu XB, Hu WM and Sutton R designed the research, corrected and approved the manuscript; Xiong JJ, Altaf K and Tan CL developed the literature search and carried out statistical analyses of the studies; Javed MA, Huang W, Mai G and Mukherjee R performed data extraction; Xiong JJ, Altaf K and Nunes QM wrote the manuscript; All authors read and approved the final manuscript.
Correspondence to: Xu-Bao Liu, MD, PhD, Professor, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Guoxue Road 37, Chengdu 610041, Sichuan Province, China. liuxb2011@126.com
Telephone: +86-28-85422474 Fax: +86-28-85422872
Received: December 19, 2012
Revised: January 11, 2013
Accepted: January 23, 2013
Published online: February 21, 2013
Abstract

AIM: To conduct a meta-analysis to compare Roux-en-Y (R-Y) gastrojejunostomy with gastroduodenal Billroth I (B-I) anastomosis after distal gastrectomy (DG) for gastric cancer.

METHODS: A literature search was performed to identify studies comparing R-Y with B-I after DG for gastric cancer from January 1990 to November 2012 in Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in The Cochrane Library. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either fixed or random effects model. Operative outcomes such as operation time, intraoperative blood loss and postoperative outcomes such as anastomotic leakage and stricture, bile reflux, remnant gastritis, reflux esophagitis, dumping symptoms, delayed gastric emptying and hospital stay were the main outcomes assessed. Meta-analyses were performed using RevMan 5.0 software (Cochrane library).

RESULTS: Four randomized controlled trials (RCTs) and 9 non-randomized observational clinical studies (OCS) involving 478 and 1402 patients respectively were included. Meta-analysis of RCTs revealed that R-Y reconstruction was associated with a reduced bile reflux (OR 0.04, 95%CI: 0.01, 0.14; P < 0.00 001) and remnant gastritis (OR 0.43, 95%CI: 0.28, 0.66; P = 0.0001), however needing a longer operation time (WMD 40.02, 95%CI: 13.93, 66.11; P = 0.003). Meta-analysis of OCS also revealed R-Y reconstruction had a lower incidence of bile reflux (OR 0.21, 95%CI: 0.08, 0.54; P = 0.001), remnant gastritis (OR 0.18, 95%CI: 0.11, 0.29; P < 0.00 001) and reflux esophagitis (OR 0.48, 95%CI: 0.26, 0.89; P = 0.02). However, this reconstruction method was found to be associated with a longer operation time (WMD 31.30, 95%CI: 12.99, 49.60; P = 0.0008).

CONCLUSION: This systematic review point towards some clinical advantages that are rendered by R-Y compared to B-I reconstruction post DG. However there is a need for further adequately powered, well-designed RCTs comparing the same.

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