Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10166
Revised: February 17, 2014
Accepted: March 6, 2014
Published online: August 7, 2014
AIM: To assess the clinical significance of pouch size in total gastrectomy for gastric malignancies.
METHODS: We manually searched the English-language literature in PubMed, Cochrane Library, Web of Science and BIOSIS Previews up to October 31, 2013. Only randomized control trials comparing small pouch with large pouch in gastric reconstruction after total gastrectomy were eligible for inclusion. Two reviewers independently carried out the literature search, study selection, data extraction and quality assessment of included publications. Standard mean difference (SMD) or relative risk (RR) and corresponding 95%CI were calculated as summary measures of effects.
RESULTS: Five RCTs published between 1996 and 2011 comparing small pouch formation with large pouch formation after total gastrectomy were included. Eating capacity per meal in patients with a small pouch was significantly higher than that in patients with a large pouch (SMD = 0.85, 95%CI: 0.25-1.44, I2 = 0, P = 0.792), and the operative time spent in the small pouch group was significantly longer than that in the large pouch group [SMD = -3.87, 95%CI: -7.68-(-0.09), I2 = 95.6%, P = 0]. There were no significant differences in body weight at 3 mo (SMD = 1.45, 95%CI: -4.24-7.15, I2 = 97.7%, P = 0) or 12 mo (SMD = -1.34, 95%CI: -3.67-0.99, I2 = 94.2%, P = 0) after gastrectomy, and no significant improvement of post-gastrectomy symptoms (heartburn, RR = 0.39, 95%CI: 0.12-1.29, I2 = 0, P = 0.386; dysphagia, RR = 0.86, 95%CI: 0.58-1.27, I2 = 0, P = 0.435; and vomiting, RR = 0.5, 95%CI: 0.15-1.62, I2 = 0, P = 0.981) between the two groups.
CONCLUSION: Small pouch can significantly improve the eating capacity per meal after surgery, and may improve the post-gastrectomy symptoms, including heartburn, dysphagia and vomiting.
Core tip: Choosing the optimal pouch reconstruction in total gastrectomy is still a controversial area of clinical research, mainly due to the lack of information about the standardization of pouch design. This is the first meta-analysis about standardization of pouch reconstruction design after total gastrectomy, which suggests that the pouch size may be an important factor influencing the clinical outcome.