title: Pouch size influences clinical outcome of pouch construction after total gastrectomy: a meta-analysis.
abstract: OBJECTIVE
  To assess the clinical significance of pouch size in total gastrectomy for gastric malignancies.
  
  
  METHODS
  We manually searched the English-language literature in PubMed, Cochrane Library, Web of Science and BIOSIS Previews up to October 31, 2013. Only randomized control trials comparing small pouch with large pouch in gastric reconstruction after total gastrectomy were eligible for inclusion. Two reviewers independently carried out the literature search, study selection, data extraction and quality assessment of included publications. Standard mean difference (SMD) or relative risk (RR) and corresponding 95%CI were calculated as summary measures of effects.
  
  
  RESULTS
  Five RCTs published between 1996 and 2011 comparing small pouch formation with large pouch formation after total gastrectomy were included. Eating capacity per meal in patients with a small pouch was significantly higher than that in patients with a large pouch (SMD = 0.85, 95%CI: 0.25-1.44, I(2) = 0, P = 0.792), and the operative time spent in the small pouch group was significantly longer than that in the large pouch group [SMD = -3.87, 95%CI: -7.68-(-0.09), I (2) = 95.6%, P = 0]. There were no significant differences in body weight at 3 mo (SMD = 1.45, 95%CI: -4.24-7.15, I(2) = 97.7%, P = 0) or 12 mo (SMD = -1.34, 95%CI: -3.67-0.99, I(2) = 94.2%, P = 0) after gastrectomy, and no significant improvement of post-gastrectomy symptoms (heartburn, RR = 0.39, 95%CI: 0.12-1.29, I(2) = 0, P = 0.386; dysphagia, RR = 0.86, 95%CI: 0.58-1.27, I(2) = 0, P = 0.435; and vomiting, RR = 0.5, 95%CI: 0.15-1.62, I(2) = 0, P = 0.981) between the two groups.
  
  
  CONCLUSIONS
  Small pouch can significantly improve the eating capacity per meal after surgery, and may improve the post-gastrectomy symptoms, including heartburn, dysphagia and vomiting.
authors.affiliation: Heng-Lei Dong, Yu-Bei Huang, Feng-Ju Song, Ke-Xin Chen, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Heng-Lei
authors.initials: HL
authors.lastname: Dong
authors.affiliation: Heng-Lei Dong, Yu-Bei Huang, Feng-Ju Song, Ke-Xin Chen, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Yu-Bei
authors.initials: YB
authors.lastname: Huang
authors.affiliation: Heng-Lei Dong, Yu-Bei Huang, Feng-Ju Song, Ke-Xin Chen, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Xue-Wei
authors.initials: XW
authors.lastname: Ding
authors.affiliation: Heng-Lei Dong, Yu-Bei Huang, Feng-Ju Song, Ke-Xin Chen, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Feng-Ju
authors.initials: FJ
authors.lastname: Song
authors.affiliation: Heng-Lei Dong, Yu-Bei Huang, Feng-Ju Song, Ke-Xin Chen, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Ke-Xin
authors.initials: KX
authors.lastname: Chen
authors.affiliation: Heng-Lei Dong, Yu-Bei Huang, Feng-Ju Song, Ke-Xin Chen, Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital and Institute, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Xi-Shan
authors.initials: XS
authors.lastname: Hao
mesh_terms: D004435:Eating; D005247:Feeding Behavior; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D019738:Surgically-Created Structures / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Gastric cancer; Pouch size; Systematic review; Total gastrectomy
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