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- Title
Vagal Sparing Gastrectomy: A Systematic Review and Meta-Analysis.
- Authors
Tokhi, Ashraf M.; George, Sam V.; Cabalag, Carlos S.; Liu, David S.; Duong, Cuong P.
- Abstract
Introduction: Radical gastrectomy is associated with significant functional complications. In appropriate patients may be amenable to less invasive resection aimed at preserving the vagal trunks. The aim of this systematic review and meta-analysis was to assess the functional consequences and oncological safety of vagal sparing gastrectomy (VSG) compared to conventional non-vagal sparing gastrectomy (CG). Methods: A systematic review of four databases in accordance with PRISMA guidelines was undertaken for studies published between January 1, 1990, and December 15, 2021, comparing patients who underwent VSG to CG. We meta-analysed the following outcomes: operative time, blood loss, nodal yield, days to flatus, body weight changes, as well as the incidence of post-operative cholelithiasis, diarrhoea, delayed gastric emptying, and dumping syndrome. Results: Thirty studies were included in the meta-analysis with a selection of studies qualitatively analysed. VSG was associated with a lower rate of cholelithiasis (OR: 0.25, 95% CI: 0.15–0.41, p < 0.010) and early dumping syndrome (OR: 0.42, 95% CI: 0.21–0.86; p = 0.02), less blood loss (mean difference [MD]: −51 mL, 95% CI: −89.11 to −12.81 mL, p = 0.009), less long-term weight loss (MD: 2.03%, 95% CI: 0.31–3.76%, p = 0.02) and a faster time to flatus (MD: −0.42 days, 95% CI: −0.48 to 0.36, p < 0.001). There was no significant difference in nodal harvest, overall survival, and all other endpoints. Conclusion: VSG significantly reduces the incidence of post-operative cholelithiasis and dumping syndrome, decreases weight loss, and facilitates an earlier return of gut motility. Although technically more challenging, VSG should be considered for prophylactic surgery. Mini-Summary: Patients with early gastric cancer may benefit from vagal sparing gastrectomy specifically in relation to a reduced risk of developing cholelithiasis and superior post-operative quality of life.
- Subjects
GASTRECTOMY; VAGUS nerve; GASTRIC emptying; STOMACH cancer; GALLSTONES
- Publication
Digestive Surgery, 2024, Vol 41, Issue 3, p147
- ISSN
0253-4886
- Publication type
Article
- DOI
10.1159/000536472