Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: A systematic review and meta-analysis
Notice bibliographique
Résumé
BACKGROUND: Totally laparoscopic total gastrectomy for gastric cancer is limited to few expert surgeons, and a reason for this is the technical difficulty of performing esophagojejunostomy laparoscopically. Overlap has acted as a more popular reconstruction method in recent years; however, its clinical outcomes are inconclusive. Thus, this meta-analysis aimed to provide a higher level of evidence to demonstrate the safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy. MATERIALS AND METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to November 2021 for published English literature on retrospective research, prospective research, and randomized controlled trials of overlap anastomosis versus other anastomoses. Basic information and observation indicators of the included articles were extracted. The Cochrane Risk of Bias tool was used by the same researchers to independently assess the risk of bias in the included randomized controlled trials and evaluate the quality of cohort studies using the Newcastle-Ottawa scale. Review Manager 5.3 was used to produce forest plots for meta-analysis, funnel plots were used to assess publication bias, and sensitivity analysis was performed to evaluate result stability. RESULTS: Overall, 1534 patients from 12 studies were included in this study (738 in and 796 in the overlap and non-overlap groups, respectively). Meta-analysis of the inclusion indicators showed a lower incidence of anastomotic stenosis (OR = 0.19, 95% confidence interval [CI]: 0.09 to 0.41, P < 0.0001) compared with other anastomosis methods, with significant differences in both groups. However, no significal differences were noted between the two groups with respect to operative time (WMD = 13.79, 95% CI: -5.41 to 32.98, P = 0.16), anastomotic time (WMD = 7.18，95% CI: -5.34 to 19.69, P = 0.26), intraoperative blood loss (WMD = 19.96, 95% CI: -17.80 to 57.72, P = 0.30), number of retrieved lymph nodes (WMD = -1.33, 95% CI: -6.24 to 3.57, P = 0.59), time to first flatus (WMD = -0.11, 95% CI: -0.25 to 0.04, P = 0.14), postoperative hospital stay (WMD = -0.09, 95% CI: -1.59 to 1.41, P = 0.90), anastomotic leak (OR = 1.23, 95% CI: 0.67 to 2.27, P = 0.50), anastomotic bleeding (OR = 0.87, 95% CI: 0.28 to 2.67, P = 0.80), postoperative pulmonary infection (OR = 0.94, 95% CI: 0.34 to 2.57, P = 0.90), and mortality (OR = 1.33, 95% CI: 0.27 to 6.48, P = 0.72). CONCLUSIONS: Overlap esophagojejunostomy is a safe and effective procedure during totally laparoscopic total gastrectomy. It is superior to other types of anastomosis in reducing anastomotic stenosis rates.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,008 | 0,003 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».