Comparative evaluation of reconstructive procedures after gastrectomy with and without duodenal passage preservation in gastric cancer: a systematic review and meta-analysis

Background. Optimal reconstruction after gastrectomy (GE) in gastric cancer (GC) is currently a pressing issue, with research continuing to advance functional methods, especially those preserving duodenal passage, to improve the patient’s quality of life (QOL) and nutritional status (NS).
Objectives. An evaluation of randomised clinical trials (RCTs) targeting GC patients with radical GE and comparing duodenal passage-preserving (DPP) and non-preserving (NDPP) reconstruction techniques in terms of immediate outcomes, post-gastrectomy syndrome, NS and QOL.
Methods. Sources were mined in the PubMed, Cochrane Library, Google Scholar electronic databases, as well as CyberLeninka and eLibrary national resources. The RCTs meeting eligibility criteria (15 publications) were covered in a meta-analysis. Outcome variations were defined via odds ratio (OR), standard error estimated with 95% CI, statistical significance was assumed at p <0.05. Review Manager (RevMan v. 5.4., the Cochrane Collaboration, 2020) was used for statistical data processing.
Results. A total of 15 RCTs were surveyed (1,766 patients; 722 in DPP and 1,044 in NDPP cohort). The complication and mortality rates did not differ significantly between cohorts. The meta-analysis elicited a significant advantage of DPP-GE regarding the dumping syndrome incidence at all post-surgery terms cumulatively (OR = 0.32 [95% CI: 0.22–0.48], p = 0.00001), as well as the 3- and 12-month terms, with no difference observed for 24 months. No statistically significant DPP vs. NDPP cohort variations have been found regarding reflux, stasis syndrome or NS values. The RCTs were evidently diverse with respect to QOL assessment techniques; 4 of 7 publications reported DPP advantages, and 3 — no significant variation in QOL between the DPP and NDPP cohorts.
Conclusion. Further research is necessary to substantiate optimal reconstruction methods, particularly those restoring food passage through duodenum after GE, to facilitate the patient’s most favourable QOL and NS.