Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: A meta-analysis

Table 1 Quality assessment of the included randomized controlled studies based on the Jadad scoring system

Ref.	Randomized	Appropriate randomization	Appropriately double blinded	Description of withdrawals	Total Jadad score
Ishikawa et al[20]	Yes	Yes	No	Yes	3
Lee et al[26]	Yes	Yes	No	Yes	3
Imamura et al[27] or Hirao et al[31]	Yes	Yes	No	Yes	3

Table 2 Newcastle-Ottawa scoring system for nonrandomized comparative studies

Ref.	Selection star	Comparability star1	Outcome star	Total star
Osugi et al[9]	3	2	3	8
Shinoto et al[10]	3	2	3	8
Nunobe et al[13]	4	2	3	9
Fukuhara et al[14]	3	2	3	8
Kojima et al[21]	3	2	3	8
Namikawa et al[22]	3	2	2	7
Tanaka et al[23]	3	2	3	8
Kumagai et al[24]	3	2	1	6
Kim et al[25]	3	2	2	7

¹Factors considered: Age, gender; American Society of Anesthesiologists grading and tumor stage.

Table 3 Characteristics of included studies in the meta-analysis

Ref.	Country	Design	Group	Patients (n)	Male/female (n)	Mean age (yr)
Osugi et al[9]	Japan	Retro	R-Y	18	13/5	60.2
			B-I	25	12/13	64.7
Shinoto et al[10]	Japan	Retro	R-Y	20	NR	63 ± 12
			B-I	43	NR	63 ± 9
Nunobe et al[13]	Japan	Retro	R-Y	182	117/65	58.8
			B-I	203	127/76	58.7
Fukuhara et al[14]	Japan	Retro	R-Y	29	23/6	56.1
			B-I	41	19/22	66.0
Ishikawa et al[20]	Japan	RCT	R-Y	24	17/7	64 (43-80)
			B-I	26	19/7	61 (34-84)
Kojima et al[21]	Japan	Retro	R-Y	68	43/25	62.8 ± 12.2
			B-I	65	48/17	62.0 ± 8.9
Namikawa et al[22]	Japan	Retro	R-Y	38	22/16	71 (41-80)
			B-I	47	25/22	72 (33-86)
Tanaka et al[23]	Japan	Retro	R-Y	51	34/17	65.2
			B-I	50	34/16	66.2
Kumagai et al[24]	Japan	Retro	R-Y	95	74/21	62.7 (42-81)
			B-I	329	197/132	63.5 (29-90)
Kim et al[25]	South Korea	Retro	R-Y	26	21/5	≥ 60 (9)
			B-I	72	54/18	≥ 60 (41)
Lee et al[26]	South Korea	RCT	R-Y	47	28/19	58.5 ± 10.7
			B-I	49	31/18	60.0 ± 11.6
Imamura et al[27] or Hirao et al[31]	Japan	RCT	R-Y	169	115/54	63.9 ± 10.5
			B-I	163	105/58	64.4 ± 9.3

Retro: Retrospective observational study; RCT: Randomized controlled trial; R-Y: Roux-en-Y; B-I: Billroth-I.

Table 4 Meta-analysis of outcomes of interest

Outcome of interest	Studies	Patients (n)	OR/WMD	95%CI	P value
RCT
Operation time	3	478	40.02	13.93, 66.11	0.003
Intraoperative blood loss	3	478	26.99	-9.35, 63.33	0.15
Hospital stay	3	478	2.96	-0.00, 5.93	0.05
Anastomotic leakage	3	478	0.56	0.12, 2.66	0.47
Anastomotic stricture	3	478	1.79	0.52, 6.13	0.36
Bile reflux	2	145	0.04	0.01, 0.14	< 0.00 001
Reflux esophagitis	3	458	0.49	0.20, 1.23	0.13
Remnant gastritis	2	363	0.43	0.28, 0.66	0.000
Delayed gastric emptying	2	363	2.31	0.12	44.41
OCS
Operation time	4	718	31.3	12.99, 49.60	0.001
Intraoperative blood loss	3	620	26.9	-46.54, 100.34	0.47
Hospital stay	2	522	1.40	-0.17, 2.97	0.08
Anastomotic leakage	5	813	1.26	0.40, 3.97	0.70
Anastomotic stricture	3	658	0.94	0.31, 2.89	0.91
Bile reflux	6	757	0.21	0.08, 0.54	0.001
Reflux esophagitis	5	719	0.48	0.26, 0.89	0.02
Remnant gastritis	6	784	0.18	0.11, 0.29	< 0.00 001
Dumping symptoms	4	347	0.59	0.32, 1.12	0.11
Delayed gastric emptying	4	701	0.95	0.24, 3.74	0.94

RCT: Randomized controlled trials; OCS: Non-randomized observational clinical studies; OR: Odds ratio; WMD: Weighted mean differences.