Abstract
BackgroundCurrent 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.MethodsThis 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.ResultsOf 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).ConclusionLSSM anastomoses after oesophagectomy are superior with regard to anastomotic leak and stricture rates.
Highlights
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 most serious technical complication after oesophagectomy
This study demonstrates that stapled anastomoses, using an linear stapled/semimechanical (LSSM) technique, are associated with lower anastomotic leak rates than HS anastomoses following oesophagectomy
The LSSM technique was associated with a lower rate of anastomotic stricture than circular stapled (CS), triangulating stapled (TS) and HS anastomoses
Summary
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 most serious technical complication after oesophagectomy. Patients who experience anastomotic leakage suffer high morbidity, have a high postoperative mortality rate, ranging between 21 and 35 per cent, incur high hospital costs[3,4,5,6,7]. Several meta-analyses[10,11,12,13,14] have compared stapled and hand-sewn anastomotic techniques These studies have included both randomized and non-randomized trials, and have found no significant differences in anastomotic leak rates between the two anastomotic techniques. Anastomotic techniques can include hand-sewn (HS), circular stapled (CS), linear stapled/semimechanical (LSSM)[15,16] and triangulating stapled (TS)[17,18]. 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.
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