Comparison Between Uncut Roux-en-Y Reconstruction and Billroth II Anastomosis After Laparoscopic Distal Gastrectomy for Gastric Cancer: a Meta-analysis

To assess the efficacy as well as the safety between uncut Roux-en-Y (RY) reconstruction and Billroth II (BII) anastomosis after laparoscopic distal gastrectomy (LDG) for gastric cancer. The combination of mesh terms and free-text phrases were generally utilized to explore the database. Computer retrieval of PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), and Wanfang data were conducted by means of clinical efficacy and safety. The time is limited from the construction of the library to July 2021. All statistical evaluations were carried out by Review Manager 5.3. A total of 1208 patients from 11 studies were included in this meta-analysis. The results demonstrated that the hospital stay and time to first flatus of uncut RY were significantly shorter than that of the BII. Moreover, the gastric residue, gastritis, and bile reflux incidences of uncut RY were significantly lower than BII. The results of the meta-analysis revealed that there were no substantial differences between the two groups in the operative time, intraoperative blood loss, nutritional status, and incidence of duodenal stump leakage and anastomotic leakage. Uncut RY reconstruction did not increase operative blood loss, hospital stay, and time to first flatus, effectively reducing gastric residue, gastritis, and bile reflux incidences after LDG. Although it is comparable to BII anastomosis, uncut RY does not offer the advantages such as shorter operative time and better nutritional status. More large-sample, high-quality multicenter RCTs should be able to validate the above conclusions.