Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis
Research output: Contribution to journal › Article › peer-review
Colleges, School and Institutes
- Department of Upper Gastrointestinal SurgeryUniversity Hospitals Birmingham NHS Foundation Trust Birmingham UK
- Regional Oesophago‐Gastric UnitRoyal Surrey NHS Foundation Trust Guildford UK
- Department of SurgeryFondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman HospitalNewcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK
- University of Birmingham
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.
|Early online date||23 May 2020|
|Publication status||Published - 3 Aug 2020|