Complications in Patients after Side-to-side Esophagogastric Anastomosis: A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUWen-teng ¹ , CAIQian-qian ¹ , LINRui-jiang ¹ , MAMin-jie ² , WEINing ² , ZHANGYu ² , YANGKan ² ,  HANBiao ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, P. R. China;
2. The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Esophagogastric anastomosis; Side-to-side anastomosis; Randomized controlled trials; Systematic review/Meta-analysis

DOI：

10.7507/1007-4848.20160054

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Objective To systematically review the impact of side-to-side esophagogastric anastomosis on postoperative anastomostic leak, fibrosis stricture and stroesophageal reflux. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 4 2015), Web of Science, CNKI, CBM, Wanfang Database and VIP up to April 2015. Randomized controlled trials involving the complications after side-to-side esophagogastric anastomosis were included. Data were extracted and methodological quality was evaluated by two reviewers independently with a designed extraction form. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 studies involving 684 patients were included. The results of meta-analysis showed that comparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidence of fibrosis stricture with RR=0.20 and 95% CI 0.11 to 0.36 (P<0.000 01). There was no statistical difference in incidence of postoperative anasotmostic leaks with RR=0.71 and 95% CI 0.43 to 1.19 (P=0.19) or stroesophageal reflux with RR=0.74 and 95% CI 0.50 to 1.11 (P=0.15) between the two groups. Conclusion Comparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidences of fibrosis stricture, but there is no statistical difference in anastomostic leak or stroesophageal reflux.

Citation： HUWen-teng, CAIQian-qian, LINRui-jiang, MAMin-jie, WEINing, ZHANGYu, YANGKan, HANBiao. Complications in Patients after Side-to-side Esophagogastric Anastomosis: A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 224-229. doi: 10.7507/1007-4848.20160054 Copy

1.	Siefel R, Miller K, Jemaal A. Cancer statistics. CA Cancer J Clin, 2015, 65: 5-29.22.
2.	Parkin DM. Global cancer statistics in the year 2000. The lancet oncology, 2001, 2(9): 533-543.
3.	Villaflor VM, Allaic ME, Minsky B, et al. Multidisciplinary approach for patients with esophageal cancer. WJG, 2012, 18(46): 6737.
4.	王文凭, 陈龙奇. 食管癌外科治疗的现状与展望. 中国胸心血管外科临床杂志, 2011, 18(1): 58-65.
5.	Honda M, Kuriyama A, Noma H, et al. Hand-sewn versus mecha-nical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg, 2013, 257(2): 238-248.
6.	Godoy MC, Bruzzi JF, Viswanathan C, et al. Multimodality imaging evaluation of esophageal cancer: staging, therapy assessment, and complications. Abdominal Imaging, 2013, 38(5): 974-993.
7.	Zhou D, Liu QX, Deng XF, et al. Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: a meta-analysis. J Cardiothorac Surg, 2015, 10(1): 67.
8.	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.
9.	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.
10.	Raz DJ, Tedesco P, Herbella FA, et al. Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis. Dis Esophagus, 2008, 21(1): 69-72.
11.	Deng XF, Liu QX, Zhou D, et al. Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: A meta-analysis. WJG, 2015, 21(15): 4757-4764.
12.	Higgins J. Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0. The Cochrane Collaboration, 2011, 5(10):125-239.
13.	武玉兵, 张京楠, 孙毅, 等. 食管胃颈部侧侧全机械性吻合法在食管癌切除中的临床应用研究. 中国医药指南, 2015, (7): 112-112, 113.
14.	余勇, 胡振东,张勤,等. 食管胃胸腔内侧侧吻合的临床效果. 江苏医药, 2015, 41(5): 2.
15.	马忠厦, 徐有望, 代传宙, 等. 全机械性食管胃颈部侧侧吻合在食管癌切除术中的应用. 延边医学, 2014, (21): 37-38.
16.	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, (14):115-117.
17.	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 stric-ture. World J Surg, 2013, 37(5): 1043-1050.
18.	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.
19.	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.
20.	Egberts JH, Schniewind B, Bestmann B, et al. Impact of the site of anastomosis after oncologic esophagectomy on quality of life-a prospective, longitudinal outcome study. Ann Surg Oncol, 2008, 15(2): 566-575.
21.	Lerut T, Coosemans W, Decker G, et al. Anastomotic complications after esophagectomy. Digest Surg, 2002, 19(2): 92-98.
22.	Akiyama H. Chief editor. Surgery for cancer of the esophagus. Hiroshi Akiyama: Williams & Wilkins; 1990.
23.	龙梦云, 韦诗友, 黄芊, 等. 两种食管上提径路对食管癌患者术后并发症影响的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(2): 91-99.
24.	高旭辉, 刘雷霆, 朱水波, 等食管癌患者食管-管状胃环形吻合器端侧吻合与半器械侧侧吻合近期治疗效果观察. 临床外科杂志, 2015, (4): 305-307.
25.	Aly A, Jamieson GG, Watson DI, et al. An antireflux anastomosis following esophagectomy: a randomized controlled trial. J Gastroin-test Surg, 2010, 14(3): 470-475.
26.	Lee J, Anggiansah A, Anggiansah R, et al. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterology Hepatology, 2007, 5(12): 1392-1398.
27.	Paterson WG. The normal antireflux mechanism. Chest surgery clinics of North America, 2001, 11(3): 473-483.
28.	Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogas-tric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1): 177-185.
29.	Aly A, Jamieson G, Pyragius M, et al. Antireflux anastomosis following oesophagectomy. ANZ J Surg, 2004, 74(6): 434-438.

1. Siefel R, Miller K, Jemaal A. Cancer statistics. CA Cancer J Clin, 2015, 65: 5-29.22.
2. Parkin DM. Global cancer statistics in the year 2000. The lancet oncology, 2001, 2(9): 533-543.
3. Villaflor VM, Allaic ME, Minsky B, et al. Multidisciplinary approach for patients with esophageal cancer. WJG, 2012, 18(46): 6737.
4. 王文凭, 陈龙奇. 食管癌外科治疗的现状与展望. 中国胸心血管外科临床杂志, 2011, 18(1): 58-65.
5. Honda M, Kuriyama A, Noma H, et al. Hand-sewn versus mecha-nical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg, 2013, 257(2): 238-248.
6. Godoy MC, Bruzzi JF, Viswanathan C, et al. Multimodality imaging evaluation of esophageal cancer: staging, therapy assessment, and complications. Abdominal Imaging, 2013, 38(5): 974-993.
7. Zhou D, Liu QX, Deng XF, et al. Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: a meta-analysis. J Cardiothorac Surg, 2015, 10(1): 67.
8. 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.
9. 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.
10. Raz DJ, Tedesco P, Herbella FA, et al. Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis. Dis Esophagus, 2008, 21(1): 69-72.
11. Deng XF, Liu QX, Zhou D, et al. Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: A meta-analysis. WJG, 2015, 21(15): 4757-4764.
12. Higgins J. Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0. The Cochrane Collaboration, 2011, 5(10):125-239.
13. 武玉兵, 张京楠, 孙毅, 等. 食管胃颈部侧侧全机械性吻合法在食管癌切除中的临床应用研究. 中国医药指南, 2015, (7): 112-112, 113.
14. 余勇, 胡振东,张勤,等. 食管胃胸腔内侧侧吻合的临床效果. 江苏医药, 2015, 41(5): 2.
15. 马忠厦, 徐有望, 代传宙, 等. 全机械性食管胃颈部侧侧吻合在食管癌切除术中的应用. 延边医学, 2014, (21): 37-38.
16. 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, (14):115-117.
17. 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 stric-ture. World J Surg, 2013, 37(5): 1043-1050.
18. 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.
19. 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.
20. Egberts JH, Schniewind B, Bestmann B, et al. Impact of the site of anastomosis after oncologic esophagectomy on quality of life-a prospective, longitudinal outcome study. Ann Surg Oncol, 2008, 15(2): 566-575.
21. Lerut T, Coosemans W, Decker G, et al. Anastomotic complications after esophagectomy. Digest Surg, 2002, 19(2): 92-98.
22. Akiyama H. Chief editor. Surgery for cancer of the esophagus. Hiroshi Akiyama: Williams & Wilkins; 1990.
23. 龙梦云, 韦诗友, 黄芊, 等. 两种食管上提径路对食管癌患者术后并发症影响的系统评价和Meta分析. 中国胸心血管外科临床杂志, 2015, 22(2): 91-99.
24. 高旭辉, 刘雷霆, 朱水波, 等食管癌患者食管-管状胃环形吻合器端侧吻合与半器械侧侧吻合近期治疗效果观察. 临床外科杂志, 2015, (4): 305-307.
25. Aly A, Jamieson GG, Watson DI, et al. An antireflux anastomosis following esophagectomy: a randomized controlled trial. J Gastroin-test Surg, 2010, 14(3): 470-475.
26. Lee J, Anggiansah A, Anggiansah R, et al. Effects of age on the gastroesophageal junction, esophageal motility, and reflux disease. Clin Gastroenterology Hepatology, 2007, 5(12): 1392-1398.
27. Paterson WG. The normal antireflux mechanism. Chest surgery clinics of North America, 2001, 11(3): 473-483.
28. Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogas-tric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1): 177-185.
29. Aly A, Jamieson G, Pyragius M, et al. Antireflux anastomosis following oesophagectomy. ANZ J Surg, 2004, 74(6): 434-438.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Complications in Patients after Side-to-side Esophagogastric Anastomosis: A Systematic Review and Meta-analysis

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