Background: Additional studies comparing several reconstruction methods after proximal gastrectomy have been published; of note, it is necessary to update systematic reviews and meta-analysis from the current evidence-based literature. Aim: To expand the current knowledge on feasibility and safety, and also to analyze postoperative outcomes of several reconstructive techniques after proximal gastrectomy. Methods: PubMed, Google Scholar, and Medline databases were searched for original studies, and relevant literature published between the years 1966 and 2019 concerning various reconstructive techniques on proximal gastrectomy were selected. The postoperative outcomes and complications of the reconstructive techniques were assessed. Meta-analyses were performed using Rev-Man 5.0. A total of 29 studies investigating postoperative outcomes of double tract reconstruction, jejunal pouch interposition, jejunal interposition, esophagogastrostomy, and double flap reconstruction were finally selected in the quantitative analysis. Result: Pooled incidences of reflux esophagitis for double tract reconstruction, jejunal pouch interposition, jejunal interposition esophagogastrostomy, and double flap reconstruction were 8.6%, 13.8%, 13.8%, 19.3%, and 8.9% respectively. Meta-analysis showed a decreased length of hospital in the JI group as compared to the JPI group (heterogeneity: Chi 2 = 1.34, df = 1 (P = 0.25); I 2 = 26%, test for overall effect: Z = 2.22 (P = 0.03). There was also a significant difference between JI and EG in length of hospital stay with heterogeneity: Chi 2 = 1.40, df = 3 (P = 0.71); I 2 = 0%, test for overall effect: Z = 5.04 (P < 0.00001). Operative time was less in the EG group as compared to the JI group (heterogeneity: Chi 2 = 31.09, df = 5 (P < 0.00001); I 2 = 84%, test for overall effect: Z = 32.35 (P < 0.00001).

Background Low anterior, ultralow anterior, and intersphincteric resection are conventional, elective anus-sparing techniques for low rectal cancer, and good prognosis depends on a good blood supply and tension-free anastomosis. Aim The goal is to assess the effect of preserving the arc formed by the left colic and proximal inferior mesenteric arteries (IMAs), and first branch of the sigmoid arteries on the anastomotic blood supply, tension, and leakage rate in anus-sparing surgery for low rectal cancer. Method From 2011 to 2020, a patient with low rectal cancer resection was distributed into the ligation group (42 cases with inferior mesenteric artery ligation) and the preservation group (61 cases with preservation of the left colic and proximal IMAs and first branch of the sigmoid artery). Results We evaluated patient characteristics, operative results, morbidity, and postoperative follow-up results. There were comparable outcomes between ligation and preservation groups in relations to the number of patients in each operative procedure, duration of surgery, operative blood loss, postoperative hospital stay, and the number of patients with protective stoma ( P >.05). In postoperative morbidity, there were similar outcomes between ligation and preservation groups in terms of anastomotic subclinical dehiscence, bleeding and stricture, and urinary retention ( P >.05). There were significant differences in anastomotic leakage and intra-abdominal abscess ( P < .05). Conclusion Preservation of the arterial arc formed by left colic artery, proximal IMA, and the first branch of sigmoid arteries with apical lymph node dissection could increase anastomotic blood supply, reduce anastomotic tension, and leakage rate in anus-saving treatment of low rectal cancer.

Abstract Object: The aim of this study is to compare the superiority and safety of preserving and non-preserving left colonic artery. Method: PubMed, Google scholar and Medline were searched for eligible studies between 1965 to 2018. Operative time, blood loss, number of resected lymph nodes, anastomotic leakage, and ileus, and morbidity, hospital length of stay, wound infection and mortality were the main outcome study. Result: 23 studies involving 10,644 patients were included in the analyses. Compared with the preserving approach, the non-preserving approach had less operative time (weighted mean difference [WMD]=9.37 min, 95% CI [8.92,9.81], p

1.1. Background: Presence of lateral lymph node metastasis in rectal cancer was originally reported in the 1950s.Lateral lymph node metastasis occurs in 15 to 20% of patients with locally advanced low rectal cancer which escalates likelihood of local recurrence and reduced survival following neoadjuvant chemoradiotherapy (nCRT) and Total Mesolectal Excision (TME). Aim:Our objective was to analyze the significance of lateral lymph node dissection for patients with mid lower rectal cancer. Method:Cochrane, EMBASE, PubMed, Google Scholar, and Medline databases were searched for original studies, and relevant literature published between the years 1992 and 2020 concerning Lateral lymph node dissection for patients with mid lower rectal cancer were selected. A total of 27 studies were included. The preoperative, postoperative outcomes and complications were assessed. Meta-analyses were performed using Rev-Man 5.3. Result: 27 studies were included in the analyses. Compared with the LLND No, the LLND Yes had longer operative time (WMD=86.26, 95% CI [79.59,92.93],p<0.00001), increase blood loss (WMD=148.21, 95% CI [122.29, 174.13], p =0.006), and fiveyear disease-free survival was favoring LLND No (OR= 1.58, 95% CI [ 1.12, 2.22], p=0.009).The LLND Yes resulted in a high risk of urinary dysfunction (OR= 0.16, 95% CI [0.04, 0.28],p=0.008 and there was a high risk of sexual dysfunction with LLND Yes group (OR= 2.42, 95%CI [1.55, 3.78], p=0.0009).No other significant differences were observed. Conclusion:We discovered that lateral lymph node dissection is not necessary because it did not favor the patients. It leads to longer operation time, increase blood loss and also increase morbidity rate, high risk of urinary and sexual dysfunction. Nevertheless, as there are limitations of this meta-analysis, decisions should be observed with some skepticism.