摘要
BACKGROUND Proximal gastrectomy(PG)for gastric cancer requires a delicate balance between oncological radicality and postoperative quality of life to mitigate reflux complications.Although the Kamikawa anastomosis has gained attention for its theoretical anti-reflux advantages,robust clinical evidence remains limited.AIM To comprehensively evaluate the efficacy,safety,and nutritional outcomes of the Kamikawa anastomosis in PG,thereby addressing a critical gap in surgical decision-making.METHODS Following PRISMA guidelines,we systematically searched PubMed,Embase,and the Cochrane Library for studies on Kamikawa anastomosis after PG.Data were pooled using fixed-or random-effects models based on heterogeneity levels(I2 statistics).The risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions.The protocol was prospectively registered in PROSPERO.RESULTS Of 106 screened studies,20 involving 2291 patients were included.Most studies(85%)originated from Japan,with a mean patient age of 54-73 years and a male predominance(68.1%).Overall pooled incidence of 30-day postoperative complications was 9.9%[95%confidence interval(95%CI):6.8-12.9],with major complications(Clavien-Dindo grade≥III)occurring in 6.1%(95%CI:4.6-7.7).Anastomosis-related complications were observed in 7.2%of cases,comprising leakage 1.8%(95%CI:1.1-2.4),stenosis in 7.2%(95%CI:5.8-8.5),and bleeding in 0.7%(95%CI:0.1-1.2).Pooled incidence of reflux esophagitis was 4%(95%CI:2.7-5.3)for all LA grades at 12-month follow-up,with 28.3%(95%CI:14.7-41.9)of patients requiring regular proton pump inhibitor use.Operative outcomes demonstrated a pooled mean operative time of 349.5 minutes(95%CI:331-380),estimated blood loss of 351.5 mL(95%CI:264-495),and postoperative hospital stay of 12.3 days(95%CI:11.5-13.1).Nutritional outcomes revealed 11.4%(95%CI:10.6-12.2)body weight loss at one year.Comparative analyses showed equivalent safety profiles between the Kamikawa anastomosis and double-tract reconstruction but longer operative times(P<0.001)compared with total gastrectomy.CONCLUSION These findings underscore the clinical viability of the Kamikawa anastomosis following PG,demonstrating favorable anti-reflux efficacy,acceptable incidence of anastomotic strictures,and preservation of nutritional status.
