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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2013

01-12-2013 | Thoracic Oncology

Technical Factors that Affect Anastomotic Integrity Following Esophagectomy: Systematic Review and Meta-analysis

Authors: Sheraz R. Markar, MRCS, MSc, MA, Shobhit Arya, MRCS, BSc, Alan Karthikesalingam, MRCS, MSc, MA, PhD, George B. Hanna, FRCS, PhD

Published in: Annals of Surgical Oncology | Issue 13/2013

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Abstract

Background

Due to the significant contribution of anastomotic leak, with its disastrous consequences to patient morbidity and mortality, multiple parameters have been proposed and individually meta-analyzed for the formation of the ideal esophagogastric anastomosis following cancer resection. The purpose of this pooled analysis was to examine the main technical parameters that impact on anastomotic integrity.

Methods

Medline, Embase, trial registries, and conference proceedings were searched. Technical factors evaluated included hand-sewn versus stapled esophagogastric anastomosis (EGA), cervical versus thoracic EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. The outcome of interest was the incidence of anastomotic leak, for which pooled odds ratios were calculated for each technical factor.

Results

No significant difference in the incidence of anastomotic leak was demonstrated for the following technical factors: hand-sewn versus stapled EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. Four randomized, controlled trials comprising 298 patients were included that compared cervical and thoracic EGA. Anastomotic leak was seen more commonly in the cervical group (13.64 %) than in the thoracic group (2.96 %). Pooled analysis demonstrated a significantly increased incidence of anastomotic leak in the cervical group (pooled odds ratio = 4.73; 95 % CI 1.61–13.9; P = 0.005).

Conclusions

A tailored surgical approach to the patient’s physiology and esophageal cancer stage is the most important factor that influences anastomotic integrity after esophagectomy.
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Metadata
Title
Technical Factors that Affect Anastomotic Integrity Following Esophagectomy: Systematic Review and Meta-analysis
Authors
Sheraz R. Markar, MRCS, MSc, MA
Shobhit Arya, MRCS, BSc
Alan Karthikesalingam, MRCS, MSc, MA, PhD
George B. Hanna, FRCS, PhD
Publication date
01-12-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3189-x

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