Optimal reconstruction methods after distal gastrectomy for gastric cancer

作者：Zhaolun Cai, Ye Zhou, Chenxiao Wang, Yiqiong Yin, Yuan Yin, Chaoyong Shen, Xiaonan Yin, Zhi‐Xin Chen, Bo Zhang · 发表于：Medicine · 年份：2018 · DOI：10.1097/md.0000000000010823 · 被引用次数：64 · 研究领域：Gastric Cancer Management and Outcomes、Bariatric Surgery and Outcomes、Reconstructive Surgery and Microvascular Techniques

BACKGROUND: The choice of anastomosis methods including Billroth I, Billroth II, and Roux-en-Y after a distal gastrectomy is still controversial. The conventional meta-analyses assessing 2 alternative treatments were not powered to compare differences in clinical outcomes. To guide treatment decisions in patients with gastric cancer (GC) after distal gastrectomy, we did a systematic review and network meta-analysis to identify the best reconstruction method. METHODS: We systematically searched PubMed, EMBASE, the Cochrane Library for randomized controlled trials comparing the outcomes of Billroth I, Billroth II, or Roux-en-Y reconstruction after distal subtotal gastrectomy for patients with GC, then we performed a direct meta-analysis and Bayesian network meta-analysis to pooled odds ratios (OR) or weighted mean differences (WMD) with 95% credible intervals (CrI) with random effects model. The node-splitting method was used to assess the inconsistency. We estimated the potential ranking probability of treatments by calculating the surface under the cumulative ranking curve for each intervention. RESULTS: Nine studies involving 1161 patient were included in the network meta-analysis. Statistical significance was reached for the comparisons of Roux-en-Y versus Billroth I reconstruction (WMD 37, 95% Crl: 22-51) and Billroth II versus Billroth I reconstruction (WMD 25, 95% Crl: 5.8-43) for operation time; and Roux-en-Y versus Billroth I reconstruction (WMD 26, 95% Crl: 2.1-68) fo...