Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: A systematic review and meta-analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.003 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".