Abstract
ObjectivesTo conduct a systematic review and meta-analysis of studies comparing the gastric-tube vs. whole-stomach for esophageal cancer in order to determine the optimal surgical technique of esophagectomy.MethodsA comprehensive literature search was performed using PubMed, EMBASE, ScienceDirect, Ovid MEDLINE, Cochrane Library, Web of Science, Google Scholar, and Scopus. Clinical trials that compared the gastric-tube versus whole-stomach for esophageal cancer were selected. The clinical endpoints included anastomotic leakage, anastomotic stenosis, reflux esophagitis, pneumonia, delayed gastric emptying, and thoracic stomach syndrome.ResultsA total of 6 articles (1571 patients) were included. Compared to the whole-stomach approach, the gastric-tube approach was associated with a lower incidence of reflux esophagitis (95% confidence interval [CI]: 0.16 to 0.81, p = 0.01) and thoracic stomach syndrome (95% CI: 0.17 to 0.55, p < 0.0001). The rates of anastomotic leakage, anastomotic stenosis, pneumonia, and delayed gastric emptying did not significantly differ between the two groups.ConclusionsThe gastric-tube esophagectomy is superior to the whole-stomach approach, as it is associated with a lower incidence of postoperative reflux esophagitis and thoracic stomach syndrome. Our findings must be validated in large-scale randomized controlled trials.
Highlights
Esophageal cancer is a common type of cancer worldwide, and is associated with a high mortality rate [1, 2]
Compared to the whole-stomach approach, the gastric-tube approach was associated with a lower incidence of reflux esophagitis (95% confidence interval [CI]: 0.16 to 0.81, p = 0.01) and thoracic stomach syndrome
The gastric-tube esophagectomy is superior to the whole-stomach approach, as it is associated with a lower incidence of postoperative reflux esophagitis and thoracic stomach syndrome
Summary
Esophageal cancer is a common type of cancer worldwide, and is associated with a high mortality rate [1, 2]. The most suitable method of digestive tract reconstruction after esophagectomy for esophageal cancer is the anastomosis of the esophageal remnant with the stomach, as this ensures a reliable blood supply [5, 6]. Both the gastric-tube and whole-stomach approaches are widely used for esophagogastric anastomosis [7, 8]. To determine the optimal technique, we conducted a systematic review and meta-analysis of studies investigating esophagectomy with gastric-tube and whole-stomach for the treatment of esophageal cancer
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