ArticleWorld journal of gastrointestinal surgery2025
Kamikawa anastomosis in proximal gastrectomy for gastric cancer: A systematic review and meta-analysis.
Article in World journal of gastrointestinal surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundProximal 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.
aimTo comprehensively evaluate the efficacy, safety, and nutritional outcomes of the Kamikawa anastomosis in PG, thereby addressing a critical gap in surgical decision-making.
methodsFollowing 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 (
resultsOf 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 (
conclusionThese 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.
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