학술논문
Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis
Systematic review
Systematic review
Document Type
Academic Journal
Source
BJS Open. August 2020, Vol. 4 Issue 4, p563, 14 p.
Subject
Language
English
Abstract
Introduction Despite improvements in perioperative care over recent decades, which have led to improved patient selection, reduced operative morbidity and mortality, and prolonged postoperative survival (1,2), anastomotic leak remains the [...]
Background: 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.
Background: 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.