Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2025; 17(8): 107706
Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.107706
Kamikawa anastomosis in proximal gastrectomy for gastric cancer: A systematic review and meta-analysis
Cheng-Cong Liu, Jian Yang, Gang Yin, Zhen Tian, Chen Qin
Cheng-Cong Liu, Department of Gastrointestinal Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, Shandong Province, China
Jian Yang, Department of General Surgery, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, Shandong Province, China
Gang Yin, Department of Blood Transfusion, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, Shandong Province, China
Zhen Tian, Medical School, Nanjing University, Nanjing 266000, Jiangsu Province, China
Chen Qin, Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao 266000, Shandong Province, China
Author contributions: Liu CC, Yang J, Yin G, Tian Z, and Qin C designed the research; Liu CC and Yang J were responsible for data acquisition, analysis, and interpretation; Liu CC wrote the paper; Yang J, Yin G, Tian Z, and Qin C reviewed the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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 that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen Qin, MD, Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, No. 127 Siliu South Road, Qingdao 266000, Shandong Province, China. qinchenqinchen123@126.com
Received: March 28, 2025
Revised: May 22, 2025
Accepted: July 2, 2025
Published online: August 27, 2025
Processing time: 150 Days and 22.4 Hours
Abstract
BACKGROUND

Proximal gastrectomy (PG) for gastric cancer requires a delicate balance between oncological radicality and postoperative quality of life to mitigate reflux complications. Although the Kamikawa anastomosis has gained attention for its theoretical anti-reflux advantages, robust clinical evidence remains limited.

AIM

To comprehensively evaluate the efficacy, safety, and nutritional outcomes of the Kamikawa anastomosis in PG, thereby addressing a critical gap in surgical decision-making.

METHODS

Following PRISMA guidelines, we systematically searched PubMed, Embase, and the Cochrane Library for studies on Kamikawa anastomosis after PG. Data were pooled using fixed- or random-effects models based on heterogeneity levels (I2 statistics). The risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions. The protocol was prospectively registered in PROSPERO.

RESULTS

Of 106 screened studies, 20 involving 2291 patients were included. Most studies (85%) originated from Japan, with a mean patient age of 54-73 years and a male predominance (68.1%). Overall pooled incidence of 30-day postoperative complications was 9.9% [95% confidence interval (95%CI): 6.8-12.9], with major complications (Clavien-Dindo grade ≥ III) occurring in 6.1% (95%CI: 4.6-7.7). Anastomosis-related complications were observed in 7.2% of cases, comprising leakage 1.8% (95%CI: 1.1-2.4), stenosis in 7.2% (95%CI: 5.8-8.5), and bleeding in 0.7% (95%CI: 0.1-1.2). Pooled incidence of reflux esophagitis was 4% (95%CI: 2.7-5.3) for all LA grades at 12-month follow-up, with 28.3% (95%CI: 14.7-41.9) of patients requiring regular proton pump inhibitor use. Operative outcomes demonstrated a pooled mean operative time of 349.5 minutes (95%CI: 331-380), estimated blood loss of 351.5 mL (95%CI: 264-495), and postoperative hospital stay of 12.3 days (95%CI: 11.5-13.1). Nutritional outcomes revealed 11.4% (95%CI: 10.6-12.2) body weight loss at one year. Comparative analyses showed equivalent safety profiles between the Kamikawa anastomosis and double-tract reconstruction but longer operative times (P < 0.001) compared with total gastrectomy.

CONCLUSION

These findings underscore the clinical viability of the Kamikawa anastomosis following PG, demonstrating favorable anti-reflux efficacy, acceptable incidence of anastomotic strictures, and preservation of nutritional status.

Keywords: Double-flap technique; Kamikawa; Proximal gastrectomy; Gastric cancer

Core Tip: This systematic review and meta-analysis evaluates the efficacy, safety, and nutritional outcomes of Kamikawa anastomosis following proximal gastrectomy for gastric cancer. Our findings suggest that Kamikawa anastomosis offers favorable anti-reflux benefits with a low incidence of anastomotic complications, including leakage and stenosis. The procedure is associated with acceptable postoperative outcomes, although it requires longer operative times compared to total gastrectomy. Despite some nutritional loss, the overall clinical profile supports its viability as an option for proximal gastrectomy, addressing a significant gap in surgical decision-making for gastric cancer.