Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis
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 techn...
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Oxford University Press
2020-08-01
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Online Access: | https://doi.org/10.1002/bjs5.50298 |
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doaj-d4da49ed4bfa4d77b425dbb2f80163c52021-04-02T11:42:42ZengOxford University PressBJS Open2474-98422020-08-014456357610.1002/bjs5.50298Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysisS. K. Kamarajah0J. R. Bundred1P. Singh2S. Pasquali3E. A. Griffiths4Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UKCollege of Medical and Dental Sciences Birmingham UKDepartment of Upper Gastrointestinal Surgery University Hospitals Birmingham NHS Foundation Trust Birmingham UKDepartment of Surgery Fondazione IRCCS Istituto Nazionale dei Tumori Milan ItalyInstitute of Cancer and Genomic Sciences, College of Medical and Dental Sciences University of Birmingham Birmingham UKBackground 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.https://doi.org/10.1002/bjs5.50298 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
S. K. Kamarajah J. R. Bundred P. Singh S. Pasquali E. A. Griffiths |
spellingShingle |
S. K. Kamarajah J. R. Bundred P. Singh S. Pasquali E. A. Griffiths Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis BJS Open |
author_facet |
S. K. Kamarajah J. R. Bundred P. Singh S. Pasquali E. A. Griffiths |
author_sort |
S. K. Kamarajah |
title |
Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis |
title_short |
Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis |
title_full |
Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis |
title_fullStr |
Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis |
title_full_unstemmed |
Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis |
title_sort |
anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta‐analysis |
publisher |
Oxford University Press |
series |
BJS Open |
issn |
2474-9842 |
publishDate |
2020-08-01 |
description |
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. |
url |
https://doi.org/10.1002/bjs5.50298 |
work_keys_str_mv |
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