Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis.
Kamarajah, S K Bundred, J R Singh, P Pasquali, S Griffiths, E A
Kamarajah, S K
Bundred, J R
Singh, P
Pasquali, S
Griffiths, E A
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2020-05-23
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Abstract
ackground: Current evidence on the benefits of different anastomotic techniques (hand-sewn (HS), circular stapled (CS), triangulating stapled (TS) or linear stapled/semimechanical (LSSM) techniques) after oesophagectomy is conflicting. The aim of this study was to evaluate the evidence for the techniques for oesophagogastric anastomosis and their impact on perioperative outcomes.
Methods: This was a systematic review and network meta-analysis. PubMed, EMBASE and Cochrane Library databases were searched systematically for randomized and non-randomized studies reporting techniques for the oesophagogastric anastomosis. Network meta-analysis of postoperative anastomotic leaks and strictures was performed.
Results: Of 4192 articles screened, 15 randomized and 22 non-randomized studies comprising 8618 patients were included. LSSM (odds ratio (OR) 0·50, 95 per cent c.i. 0·33 to 0·74; P = 0·001) and CS (OR 0·68, 0·48 to 0·95; P = 0·027) anastomoses were associated with lower anastomotic leak rates than HS anastomoses. LSSM anastomoses were associated with lower stricture rates than HS anastomoses (OR 0·32, 0·19 to 0·54; P < 0·001).
Conclusion: LSSM anastomoses after oesophagectomy are superior with regard to anastomotic leak and stricture rates.
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Kamarajah SK, Bundred JR, Singh P, Pasquali S, Griffiths EA. Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis. BJS Open. 2020 Aug;4(4):563-576. doi: 10.1002/bjs5.50298. Epub 2020 May 23
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