Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis

Research output: Contribution to journalArticlepeer-review

Authors

  • S. K. Kamarajah
  • J. R. Bundred
  • P. Singh
  • S. Pasquali
  • E. A. Griffiths

Colleges, School and Institutes

External organisations

  • 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

Abstract

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.

Bibliographic note

© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.

Details

Original languageEnglish
Pages (from-to)563-576
JournalBJS Open
Volume4
Issue number4
Early online date23 May 2020
Publication statusPublished - 3 Aug 2020