Oncometabolic Surgery: The Metabolic Effects and Effectiveness of the Different Reconstruction Methods used in Gastric Cancer Surgery. A Systematic Review and Meta-Analysis.

Abstract

Background: Gastric Cancer (GC) is the fifth most common cancer worldwide. With the development of screening programmes, early stages of GC began being detected, giving rise to a new concern: Quality of Life. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HBP), and body mass index (BMI) reduction rate and to provide an overview of recent research on oncometabolic surgery (OS). Methods: We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y (RY) reconstruction, and residual stomach on T2DM, HBP, and BMI reduction rate. Heterogeneity was assessed using the I2 statistics. Results: We included 31 studies in the qualitative synthesis and 18 in the quantitative synthesis. At the end of the follow-up, the duodenal bypass group had a significantly higher postoperative partial and complete remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95%CI) [1.27; 1.62]) and 1.3 (95%CI [1.00; 1.69]), respectively. Compared with the Billroth II group, RY reconstruction had significantly greater T2DM remission after gastrectomy (RR=1.19; 95%CI [1.08; 1.31]), while HBP showed no statistically significant differences. Regarding the improvement of HBP, total gastrectomy was significantly superior to partial gastrectomy (95%CI [1.01; 2.64]; p=0.046). Although there were no significant differences in the extent of gastrectomy, a trend towards RY Esophagojejunostomy as the best option for T2DM remission was observed (95%CI [0.98; 2.77]; p=0.06). Conclusion: Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Gastrectomy with long-limb Roux-en-Y reconstruction should be considered for patients with early-stage GC, concomitant metabolic diseases, and no surgery contraindications. Further research is needed to assess the impact of OS on metabolic diseases.