Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANGJie ^1,2 , WEIShi-you ² , ZHOUYing ² , YULe ² , GAOQiang ^1,2 ,  CHENLong-qi ^1,2

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHENLong-qi, Email: drchenlq@gmail.com

Keywords：

Esophageal cancer; Morbidity; Semi-mechanical anastomosis; Hand-sewn anastomosis; Systematic review

DOI：

10.7507/1007-4848.20140192

Video：

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Objective To investigate the influence of semi-mechanical and hand-sewn esophagogastric anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. Methods A systematic, computer-aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials (RCT)and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. Results Twelve relevant studies with 1 271 patients were included (3 RCTs and 9 observational studies).No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis.There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.34, 95%CI (0.12, 0.97), P < 0.05;observational studies OR=0.40, 95%CI (0.26, 0.62), P < 0.05]. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.14, 95%CI (0.04, 0.47), P < 0.05;observational studies OR=0.22, 95%CI (0.15, 0.34), P < 0.000 1]. Conclusions Compared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anastomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.

Citation： YANGJie, WEIShi-you, ZHOUYing, YULe, GAOQiang, CHENLong-qi. Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 663-669. doi: 10.7507/1007-4848.20140192 Copy

1.	赫捷, 邵康.中国食管癌流行病学现状、诊疗现状及未来对策.中国癌症杂志, 2011, 21(7):501-504.
2.	杨列, 郑轶峰, 姜建青, 等.不同食管胃吻合方式对术后并发症影响的Meta分析.循证医学, 2013, 13(3):173-180.
3.	Stein HJ, Sendler A, Fink U, et al. Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am, 2000, 80(2):659-682.
4.	Kondra J, Ong SR, Clifton J, et al. A change in clinical practice:a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5):422-429.
5.	全雪梅, 王者生, 王振元, 等.食管癌术后并发症分析及探讨.辽宁医学杂志, 2009, 23(6):296-298.
6.	刘奎.食管吻合口瘘诊疗进展.医学综述, 2012, 18(8):1191-1194.
7.	张雪飞, 史小男, 韩彪.机械与手工食管胃吻合术后吻合口瘘发生率比较的系统评价.中国循证医学杂志, 2012, 12(11):1367-1371.
8.	贲晓松, 陈刚, 唐继鸣, 等.食管-胃颈部侧侧机械吻合法在三切口食管癌切除术中的应用.中国癌症杂志, 2010, 20(2):130-133.
9.	胡风标, 邹志强, 袁耒, 等.半机械侧吻合和手工吻合两种食管胃颈部吻合术式的疗效比较.中国现代药物应用, 2013, 7(14):95-97.
10.	应开军, 黄利荣, 吴广洲, 等.三切口食管癌手术颈部半机械侧侧吻合与手工吻合吻合口并发症的比较.江苏医药, 2013, 39(19):2333-2335.
11.	Saluja SS, Ray S, Pal S, et al. Randomized trial comparing Side-to-Side stapled and Hand-Sewn esophagogastric anastomosis in neck. J Gastrointest Surg, 2012, 16(7):1287-1295.
12.	杨列, 郑轶峰, 姜建青, 等.食管癌切除术后颈部食管胃侧侧吻合与手工端侧吻合效果的对照研究.重庆医学, 2012, 41(30):3155-3156, 3159.
13.	张建国, 于振涛, 任鹏, 等.食管癌切除术后食管胃侧侧吻合技术的应用现状.中国肿瘤临床, 2010, 37(16):958-960.
14.	陈泽鑫, 刘慧, 潘益峰, 等.试验性和观察性研究相关医学文献质量评价方法.中国循证医学杂志, 2011, 11(11):1229-1236.
15.	Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5):1805-1813.
16.	Casson AG, Porter GA, Veugelers PJ. Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus, 2002, 15(4):296-302.
17.	Singh D, Maley RH, Santucci T, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg, 2001, 71(2):419-424.
18.	Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5):1043-1050.
19.	Xu QR, Wang KN, Wang WP, et al. Linear stapled esophagogastros-tomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture:a comparative clinical study. J Gastrointest Surg, 2011, 15(6):915-921.
20.	胡为才, 何苡, 侯广杰, 等.食管癌手术颈部食管-胃吻合3种技术临床应用分析.中华实用诊断与治疗杂志, 2013, 27(10):1034-1035.
21.	黄韬, 洪文娟, 张璟, 等.半机械吻合与手工吻合对食管癌术后颈部吻合口狭窄的影响.中国癌症杂志, 2012, 22(12):920-923.
22.	龚太乾, 蒋耀光, 王如文, 等.食管癌术后早期并发症及死亡原因分析.中国胸心血管外科临床杂志, 2005, 12(3):173-176.
23.	王从容.食管癌术后吻合口瘘原因分析及防治现状.西部医学, 2013, 25(7):1118-1119.
24.	Urschel JD, Blewett CJ, Bennett WF, et al. Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer:meta-analysis of randomized controlled trials. Dis Esophagus, 2001, 14(3-4):212-217.
25.	吴云飞, 税跃平.食管胃机械侧侧吻合在食管癌及贲门癌治疗的临床应用.吉林医学, 2011, 32(35):7451-7452.
26.	张永明, 杨文锋, 李兆敏, 等.食管、管状胃侧侧吻合预防食管癌术后吻合口狭窄效果观察.山东医药, 2011, 51(14):48-49.

1. 赫捷, 邵康.中国食管癌流行病学现状、诊疗现状及未来对策.中国癌症杂志, 2011, 21(7):501-504.
2. 杨列, 郑轶峰, 姜建青, 等.不同食管胃吻合方式对术后并发症影响的Meta分析.循证医学, 2013, 13(3):173-180.
3. Stein HJ, Sendler A, Fink U, et al. Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am, 2000, 80(2):659-682.
4. Kondra J, Ong SR, Clifton J, et al. A change in clinical practice:a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5):422-429.
5. 全雪梅, 王者生, 王振元, 等.食管癌术后并发症分析及探讨.辽宁医学杂志, 2009, 23(6):296-298.
6. 刘奎.食管吻合口瘘诊疗进展.医学综述, 2012, 18(8):1191-1194.
7. 张雪飞, 史小男, 韩彪.机械与手工食管胃吻合术后吻合口瘘发生率比较的系统评价.中国循证医学杂志, 2012, 12(11):1367-1371.
8. 贲晓松, 陈刚, 唐继鸣, 等.食管-胃颈部侧侧机械吻合法在三切口食管癌切除术中的应用.中国癌症杂志, 2010, 20(2):130-133.
9. 胡风标, 邹志强, 袁耒, 等.半机械侧吻合和手工吻合两种食管胃颈部吻合术式的疗效比较.中国现代药物应用, 2013, 7(14):95-97.
10. 应开军, 黄利荣, 吴广洲, 等.三切口食管癌手术颈部半机械侧侧吻合与手工吻合吻合口并发症的比较.江苏医药, 2013, 39(19):2333-2335.
11. Saluja SS, Ray S, Pal S, et al. Randomized trial comparing Side-to-Side stapled and Hand-Sewn esophagogastric anastomosis in neck. J Gastrointest Surg, 2012, 16(7):1287-1295.
12. 杨列, 郑轶峰, 姜建青, 等.食管癌切除术后颈部食管胃侧侧吻合与手工端侧吻合效果的对照研究.重庆医学, 2012, 41(30):3155-3156, 3159.
13. 张建国, 于振涛, 任鹏, 等.食管癌切除术后食管胃侧侧吻合技术的应用现状.中国肿瘤临床, 2010, 37(16):958-960.
14. 陈泽鑫, 刘慧, 潘益峰, 等.试验性和观察性研究相关医学文献质量评价方法.中国循证医学杂志, 2011, 11(11):1229-1236.
15. Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5):1805-1813.
16. Casson AG, Porter GA, Veugelers PJ. Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus, 2002, 15(4):296-302.
17. Singh D, Maley RH, Santucci T, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg, 2001, 71(2):419-424.
18. Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5):1043-1050.
19. Xu QR, Wang KN, Wang WP, et al. Linear stapled esophagogastros-tomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture:a comparative clinical study. J Gastrointest Surg, 2011, 15(6):915-921.
20. 胡为才, 何苡, 侯广杰, 等.食管癌手术颈部食管-胃吻合3种技术临床应用分析.中华实用诊断与治疗杂志, 2013, 27(10):1034-1035.
21. 黄韬, 洪文娟, 张璟, 等.半机械吻合与手工吻合对食管癌术后颈部吻合口狭窄的影响.中国癌症杂志, 2012, 22(12):920-923.
22. 龚太乾, 蒋耀光, 王如文, 等.食管癌术后早期并发症及死亡原因分析.中国胸心血管外科临床杂志, 2005, 12(3):173-176.
23. 王从容.食管癌术后吻合口瘘原因分析及防治现状.西部医学, 2013, 25(7):1118-1119.
24. Urschel JD, Blewett CJ, Bennett WF, et al. Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer:meta-analysis of randomized controlled trials. Dis Esophagus, 2001, 14(3-4):212-217.
25. 吴云飞, 税跃平.食管胃机械侧侧吻合在食管癌及贲门癌治疗的临床应用.吉林医学, 2011, 32(35):7451-7452.
26. 张永明, 杨文锋, 李兆敏, 等.食管、管状胃侧侧吻合预防食管癌术后吻合口狭窄效果观察.山东医药, 2011, 51(14):48-49.

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Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis

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