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
Year: 2026
Type: article
Abstract: Background: 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. Methods: 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. Results: =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. Conclusions: 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.
Authors: Hisham Ali Alghamdi, Abdullah Yahya Abdullah Al-Zahrani, Mohammed Saeed Alghamdi, Abdullatif Abdullah Alghamdi, Raghad Mansour Al-Ghamdi, Saad Dafer Ali, Adham Mohammed H. Alghamdi, Anas Saleh Alghamdi, Tariq Abdullah A. Alghamdi, Jaber Mastour Jaber Alomrai, Omar Ali Z. Alghamdi, Lama Abdullah Alghamdi, Alshareef Mohamed Alshareef
Institution: Al Baha University
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223375450