Operative efficiency and perioperative safety of overlap versus π-shaped esophagojejunostomy after totally laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis.
- 1Faculty of Medicine, Al-Baha University, Al-Baha, Saudi Arabia.
- 2General Surgery Department, Al-Baha University, Al-Baha, Saudi Arabia.
Abstract
Overlap and π-shaped esophagojejunostomy are common linear-stapled reconstructions after totally laparoscopic total gastrectomy (TLTG), but whether the technical time advantage of one method is accompanied by better perioperative safety remains uncertain. This study aimed to compare the two techniques in terms of operative efficiency, recovery, and anastomotic complications. In an unfunded PROSPERO-registered meta-analysis (PROSPERO registration: CRD420261398884), PubMed/MEDLINE, Web of Science, Scopus, Cochrane CENTRAL, China National Knowledge Infrastructure (CNKI), and Wanfang were searched from inception through 29 July 2026 without language restriction. Randomized and non-randomized comparative studies of adults undergoing curative TLTG with overlap versus π-shaped reconstruction were eligible. Random-effects mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed with RoB 2 or ROBINS-I and certainty with GRADE. Thirteen studies (1,246 patients; one reported-randomized study and 12 retrospective cohorts) were included; 10 studies (982 patients) contributed to at least one meta-analysis. Compared with π-shaped reconstruction, overlap required longer total operative time (8 studies, 826 patients; MD 17.37 minutes, 95% CI: 7.67 to 27.06; I2=66.1%) and anastomosis time (8 studies, 718 patients; MD 7.61 minutes, 95% CI: 5.84 to 9.38; I2=67.6%). No clear differences were found in anastomotic leakage (9 studies, 880 patients; RR 0.76, 95% CI: 0.41 to 1.43), stenosis/stricture (RR 0.48, 95% CI: 0.12 to 1.82), any early postoperative complication (7 studies, 671 patients; RR 0.90, 95% CI: 0.66 to 1.24), blood loss, recovery, pulmonary infection, or reflux esophagitis. Most non-randomized studies had serious risk of bias; certainty was low for anastomosis time and very low for the remaining major outcomes. π-shaped reconstruction may reduce operative and anastomosis times, but the available evidence does not establish superiority in safety or recovery. Technique selection should remain individualized until prospective multicenter comparisons with standardized outcomes are available.
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BibTeX
@article{alghamdi2026operative,
title = {{Operative efficiency and perioperative safety of overlap versus π-shaped esophagojejunostomy after totally laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis.}},
author = {Hisham Ali Alghamdi and Abdullah Yahya Abdullah Al-Zahrani and Mohammed Saeed Alghamdi and Abdullatif Abdullah Alghamdi and Raghad Mansour Al-Ghamdi and Saad Dafer Ali and Adham Mohammed H Alghamdi and Anas Saleh Alghamdi and Tariq Abdullah A Alghamdi and Jaber Mastour Jaber Alomrai and Omar Ali Z Alghamdi and Lama Abdullah Alghamdi and Alshareef Mohamed Alshareef},
journal = {Journal of gastrointestinal oncology},
year = {2026},
month = aug,
doi = {10.21037/jgo-2026-0565},
url = {https://europepmc.org/article/MED/42996868},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Operative efficiency and perioperative safety of overlap versus π-shaped esophagojejunostomy after totally laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis.
AU - Hisham Ali Alghamdi
AU - Abdullah Yahya Abdullah Al-Zahrani
AU - Mohammed Saeed Alghamdi
AU - Abdullatif Abdullah Alghamdi
AU - Raghad Mansour Al-Ghamdi
AU - Saad Dafer Ali
AU - Adham Mohammed H Alghamdi
AU - Anas Saleh Alghamdi
AU - Tariq Abdullah A Alghamdi
AU - Jaber Mastour Jaber Alomrai
AU - Omar Ali Z Alghamdi
AU - Lama Abdullah Alghamdi
AU - Alshareef Mohamed Alshareef
PY - 2026
DA - 2026/08/17
JO - Journal of gastrointestinal oncology
DO - 10.21037/jgo-2026-0565
UR - https://europepmc.org/article/MED/42996868
AB - Overlap and π-shaped esophagojejunostomy are common linear-stapled reconstructions after totally laparoscopic total gastrectomy (TLTG), but whether the technical time advantage of one method is accompanied by better perioperative safety remains uncertain. This study aimed to compare the two techniques in terms of operative efficiency, recovery, and anastomotic complications. In an unfunded PROSPERO-registered meta-analysis (PROSPERO registration: CRD420261398884), PubMed/MEDLINE, Web of Science, Scopus, Cochrane CENTRAL, China National Knowledge Infrastructure (CNKI), and Wanfang were searched from inception through 29 July 2026 without language restriction. Randomized and non-randomized comparative studies of adults undergoing curative TLTG with overlap versus π-shaped reconstruction were eligible. Random-effects mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed with RoB 2 or ROBINS-I and certainty with GRADE. Thirteen studies (1,246 patients; one reported-randomized study and 12 retrospective cohorts) were included; 10 studies (982 patients) contributed to at least one meta-analysis. Compared with π-shaped reconstruction, overlap required longer total operative time (8 studies, 826 patients; MD 17.37 minutes, 95% CI: 7.67 to 27.06; I2=66.1%) and anastomosis time (8 studies, 718 patients; MD 7.61 minutes, 95% CI: 5.84 to 9.38; I2=67.6%). No clear differences were found in anastomotic leakage (9 studies, 880 patients; RR 0.76, 95% CI: 0.41 to 1.43), stenosis/stricture (RR 0.48, 95% CI: 0.12 to 1.82), any early postoperative complication (7 studies, 671 patients; RR 0.90, 95% CI: 0.66 to 1.24), blood loss, recovery, pulmonary infection, or reflux esophagitis. Most non-randomized studies had serious risk of bias; certainty was low for anastomosis time and very low for the remaining major outcomes. π-shaped reconstruction may reduce operative and anastomosis times, but the available evidence does not establish superiority in safety or recovery. Technique selection should remain individualized until prospective multicenter comparisons with standardized outcomes are available.
SN - 2078-6891
SN - 2219-679X
ER -