Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy: A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGHang ^1,2 , TUXiang ^1,2 , WEIShi-you ^1,2 , GAOQiang ³ ,  CHENLong-qi ¹

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;
3. Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510100, P.R.China;

Corresponding author：

CHENLong-qi, Email: drchenlq@gmail.com

Keywords：

Esophageal carcinoma; Mechanical anastomosis; Hand-sewn anastomosis; Anastomotic leakage; Anastomotic stenosis; Meta-analysis

DOI：

10.7507/1007-4848.20160142

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Objective To compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. Methods Medline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. Results A total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. Conclusion Mechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.

Citation： ZHANGHang, TUXiang, WEIShi-you, GAOQiang, CHENLong-qi. Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy: A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 595-601. doi: 10.7507/1007-4848.20160142 Copy

1.	陈万青, 张思维, 曾红梅, 等. 中国2010年恶性肿瘤发病与死亡. 中国肿瘤, 2014, (01):1-10.
2.	Schweigert M, Dubecz A, Stadlhuber RJ, et al. Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation. Interact Cardiovasc Thorac Surg, 2011, 12(2):147-151.
3.	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.
4.	Suturing or stapling in gastrointestinal surgery:a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg, 1991, 78(3):337-341.
5.	Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb, 1996, 41(1):17-19.
6.	Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma:a controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3):476-483.
7.	Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer-A prospective randomized controlled trial. Ann Surg, 1997, 226(2):169-173.
8.	Laterza E, de' Manzoni G, Veraldi GF, et al. Manual compared with mechanical cervical oesophagogastric anastomosis:a randomised trial. Eur J Surg, 1999, 165(11):1051-1054.
9.	Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstructionA prospective randomized trial comparing sutured neck anastomosis with stapled intrathorocic anastomosis. Ann Surg, 2003, 238(6):803-812.
10.	Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma:a prospective randomized controlled trial. Eur J Cardio-Thorac Surg, 2004, 25(6):1097-1101.
11.	Okuyama M, Motoyama S, Suzuki H, et al. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer:A prospective randomized controlled study. Surg Today, 2007, 37(11):947-952.
12.	Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection:a prospective randomized study. J Med Assoc Thai, 2008, 91(5):681-685.
13.	Aquino JLBd, Said M, Brandi LA, et al. Tubo gástrico isoperistáltico de grande curvatura gástrica com sutura mecânica no tratamento cirúrgico do câncer de esôfago irressecável treatment of non resectable esophageal cancer. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2009, 22(3):147-152.
14.	Zhang YS, Gao BR, Wang HJ, et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer:a prospective randomized controlled trial. J Int Med Res, 2010, 38(1):227-233.
15.	Ma RD, Zhang WT, Xu QR, et al. Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture:a randomized clinical trial. Zhonghua Waide Zaahi, 2010, 48(8):577-581.
16.	Pradeep R, Mishra H, Rao S, et al. Prospective randomized trial comparing hand sewn vs linear stapler esophagogastric anastomosis. J Gastroenterol Hepatol, 2011, 26:201.
17.	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.
18.	Markar SR, Karthikesalingam A, Vyas S, et al. Hand-Sewn versus stapled oesophago-gastric anastomosis:systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5):876-884.
19.	王华, 贡力, 方良伟, 等. 食管癌术后吻合口瘘的原因及预防胃代食管左颈部吻合术后吻合口瘘的原因分析及预防. 局解手术学杂志, 2013, 22(6):685.
20.	韦春晖. 食管癌术后吻合口瘘的预防和治疗进展. 现代医药卫生, 2010, 18:2779-2781.
21.	林荣繁, 潘越江, 宋建文, 等. 食管癌、贲门癌切除术后食管胃器械吻合术213例临床观察. 广西医学, 2002, 24(6):796-798.
22.	Vigneswaran WT, Trastek VF, Pairolero PC, et al. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg, 1993, 56(4):838-844.
23.	Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2):277-287.
24.	史素霞. 食管癌术后吻合口狭窄患者的心理护理. 中国医药指南, 2014, 12(7):237-238.
25.	马利明, 高丽艳. 食管癌术后并发症的临床分析. 中国药业, 2013, 22(2):285.
26.	冯世军, 郭伟, 黄壮士. 颈部器械吻合和手工吻合在食管癌手术中的对比应用. 中国实用医刊, 2013, 40(3):63-65.
27.	李强,李晓斌. 胸中下段食管癌术后肺部并发症的临床研究. 微创医学, 2012, 7(1):9-12.
28.	刘现民. 56例食管癌、贲门癌术后肺部并发症的临床分析. 中国实用医药, 2011, 6(4):91-92.

1. 陈万青, 张思维, 曾红梅, 等. 中国2010年恶性肿瘤发病与死亡. 中国肿瘤, 2014, (01):1-10.
2. Schweigert M, Dubecz A, Stadlhuber RJ, et al. Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation. Interact Cardiovasc Thorac Surg, 2011, 12(2):147-151.
3. 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.
4. Suturing or stapling in gastrointestinal surgery:a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg, 1991, 78(3):337-341.
5. Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb, 1996, 41(1):17-19.
6. Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma:a controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3):476-483.
7. Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer-A prospective randomized controlled trial. Ann Surg, 1997, 226(2):169-173.
8. Laterza E, de' Manzoni G, Veraldi GF, et al. Manual compared with mechanical cervical oesophagogastric anastomosis:a randomised trial. Eur J Surg, 1999, 165(11):1051-1054.
9. Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstructionA prospective randomized trial comparing sutured neck anastomosis with stapled intrathorocic anastomosis. Ann Surg, 2003, 238(6):803-812.
10. Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma:a prospective randomized controlled trial. Eur J Cardio-Thorac Surg, 2004, 25(6):1097-1101.
11. Okuyama M, Motoyama S, Suzuki H, et al. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer:A prospective randomized controlled study. Surg Today, 2007, 37(11):947-952.
12. Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection:a prospective randomized study. J Med Assoc Thai, 2008, 91(5):681-685.
13. Aquino JLBd, Said M, Brandi LA, et al. Tubo gástrico isoperistáltico de grande curvatura gástrica com sutura mecânica no tratamento cirúrgico do câncer de esôfago irressecável treatment of non resectable esophageal cancer. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2009, 22(3):147-152.
14. Zhang YS, Gao BR, Wang HJ, et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer:a prospective randomized controlled trial. J Int Med Res, 2010, 38(1):227-233.
15. Ma RD, Zhang WT, Xu QR, et al. Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture:a randomized clinical trial. Zhonghua Waide Zaahi, 2010, 48(8):577-581.
16. Pradeep R, Mishra H, Rao S, et al. Prospective randomized trial comparing hand sewn vs linear stapler esophagogastric anastomosis. J Gastroenterol Hepatol, 2011, 26:201.
17. 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.
18. Markar SR, Karthikesalingam A, Vyas S, et al. Hand-Sewn versus stapled oesophago-gastric anastomosis:systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5):876-884.
19. 王华, 贡力, 方良伟, 等. 食管癌术后吻合口瘘的原因及预防胃代食管左颈部吻合术后吻合口瘘的原因分析及预防. 局解手术学杂志, 2013, 22(6):685.
20. 韦春晖. 食管癌术后吻合口瘘的预防和治疗进展. 现代医药卫生, 2010, 18:2779-2781.
21. 林荣繁, 潘越江, 宋建文, 等. 食管癌、贲门癌切除术后食管胃器械吻合术213例临床观察. 广西医学, 2002, 24(6):796-798.
22. Vigneswaran WT, Trastek VF, Pairolero PC, et al. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg, 1993, 56(4):838-844.
23. Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2):277-287.
24. 史素霞. 食管癌术后吻合口狭窄患者的心理护理. 中国医药指南, 2014, 12(7):237-238.
25. 马利明, 高丽艳. 食管癌术后并发症的临床分析. 中国药业, 2013, 22(2):285.
26. 冯世军, 郭伟, 黄壮士. 颈部器械吻合和手工吻合在食管癌手术中的对比应用. 中国实用医刊, 2013, 40(3):63-65.
27. 李强,李晓斌. 胸中下段食管癌术后肺部并发症的临床研究. 微创医学, 2012, 7(1):9-12.
28. 刘现民. 56例食管癌、贲门癌术后肺部并发症的临床分析. 中国实用医药, 2011, 6(4):91-92.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy: A Systematic Review and Meta-analysis

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