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Are intra-operative gastric drainage procedures necessary in esophagectomy: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Surgical pyloroplasty or pyloromyotomy are often performed during esophagectomy with a view of improving gastric conduit drainage. However, the clinical importance of this is not clear, and some centers opt to omit this step. The aim of this meta-analysis is to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention, in patients undergoing esophagectomy with and without a drainage procedure.

Methods

A database search of Medline, EMBASE, and Cochrane Library was performed to identify randomized control trials and cohort studies published between 2000 and 2020 which compared outcomes of esophagectomy with and without drainage procedures. A random-effects meta-analysis model was used to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention.

Results

Three randomized and 12 non-randomized publications were identified, comprising a total of 2339 patients. No significant differences were found between the two groups with regard to pulmonary complications (RR 1.02 [95% CI, 0.78–1.33], p = 0.91), anastomotic leak (RR 1.14 [95% CI, 0.80–1.62], p = 0.48), mortality (RR 0.53 [95% CI, 0.23–1.26], p = 0.15), delayed gastric emptying (RR 0.98 [95% CI, 0.59–1.62], p = 0.93), and the need for further pyloric intervention (RR 1.99 [95% CI, 0.56–7.08], p = 0.29).

Conclusion

Where post-operative pyloric treatment is available on demand, surgical pyloric drainage procedures may not have any significant clinical impact on patient outcomes for patients undergoing esophagectomy, though further good-quality randomized controlled trials are needed to confirm this.

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Authors and Affiliations

  1. Department of General Surgery, South Tees Hospitals NHS Foundation Trust, TS4 3BW, Middlesbrough, UK

    Edward J. Nevins, Igor Maleyko, Steven Terence Roy Brown, Mohamed Nauzan Mohamed Nazeer & Andrea Sangheli

  2. Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Edward J. Nevins & Alexander W. Phillips

  3. School of Medical Education, Newcastle University, Newcastle upon Tyne, UK

    Alexander W. Phillips

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  1. Edward J. Nevins
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  2. Igor Maleyko
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Contributions

EJN, IM, SB, NN, AS, and AP contributed to the study design. EJN, IM, SB, NN, and AS performed data acquisition. EJN, IM, SB, NN, AS, and AP contributed to writing the manuscript. EJN performed statistical analysis and data interpretation. AP supervised the project and provided multiple revisions of the final manuscript. All authors critically appraised and approved the final version of the manuscript prior to submission.

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Correspondence to Edward J. Nevins.

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The authors declare that there is no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical approval was not applicable for the production of this work.

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Nevins, E.J., Maleyko, I., Brown, S.T.R. et al. Are intra-operative gastric drainage procedures necessary in esophagectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 407, 3287–3295 (2022). https://doi.org/10.1007/s00423-022-02685-4

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