Supplementary Material for: Vagal sparing gastrectomy: A systematic review and meta-analysis

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 is to assess the functional consequences and oncological safety of vagal sparing gastrectomy (VSG) compared to conventional non-vagal sparing gastrectomy (CG).

A systematic review of four databases was undertaken for studies published between 1/11990 and 15/122021, 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.

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 (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 – 0.36, p<0.001). There was no significant difference in nodal harvest, overall survival, and all other endpoints.

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.

根治性胃切除术常伴随显著的功能并发症。对于适配患者，可采用旨在保留迷走神经干的微创切除手术以降低手术创伤。本系统评价与荟萃分析旨在对比保留迷走神经胃切除术（vagal sparing gastrectomy, VSG）与传统非迷走神经保留胃切除术（conventional non-vagal sparing gastrectomy, CG）的功能结局与肿瘤学安全性。

本研究检索了4个数据库，纳入1990年1月1日至2021年12月15日发表的、对比接受VSG与CG患者的相关研究。本研究对以下结局指标进行了荟萃分析：手术时长、失血量、淋巴结获取数、排气恢复天数、体重变化，以及术后胆石症、腹泻、胃排空延迟与倾倒综合征的发生率。

本荟萃分析共纳入30项研究，同时对部分研究进行了定性分析。结果显示，VSG组的术后胆石症（比值比Odds Ratio, OR=0.25，95%置信区间Confidence Interval, CI=0.15~0.41，p<0.010）与早期倾倒综合征（OR=0.42，95%CI=0.21~0.86，p=0.02）发生率更低，失血量更少（均数差Mean Difference, MD=-51ml，95%CI=-89.11~-12.81ml，p=0.009），长期体重下降幅度更小（MD=2.03%，95%CI=0.31%~3.76%，p=0.02），且排气恢复更快（MD=-0.42天，95%CI=-0.48~-0.36天，p<0.001）。两组在淋巴结获取数、总生存期及其他所有结局指标上均无显著差异。

保留迷走神经胃切除术（VSG）可显著降低术后胆石症与倾倒综合征的发生率，减轻术后体重丢失程度，并促进胃肠动力更早恢复。尽管手术技术难度更高，但仍应考虑将VSG纳入预防性手术的考量范畴。