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Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis

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Abstract

Background

Different techniques have been described for esophagojejunostomy (EJ) during laparoscopic total gastrectomy (LTG) for gastric cancer. Linear stapled techniques include overlap (OL) and functional end-to-end anastomosis (FEEA) while single staple technique (SST), hemi-double staple technique (HDST), and OrVil® are circular stapled approaches. Nowadays, the choice among techniques for EJ depends on operating surgeon personal preference.

Purpose

To compare short-term outcomes of different EJ techniques during LTG.

Methods

Systematic review and network meta-analysis. OL, FEEA, SST, HDST, and OrVil® were compared. Primary outcomes were anastomotic leak (AL) and stenosis (AS). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to measure relative inference.

Results

Overall, 3177 patients (20 studies) were included. The technique for EJ was SST (n = 1026; 32.9%), OL (n = 826; 26.5%), FEEA (n = 752; 24.1%), OrVil® (n = 317; 10.1%), and HDST (n = 196; 6.4%). AL was comparable for OL vs. FEEA (RR = 0.82; 95% CrI 0.47–1.49), OL vs. SST (RR = 0.55; 95% CrI 0.27–1.21), OL vs. OrVil® (RR = 0.54; 95% CrI 0.32–1.22), and OL vs. HDST (RR = 0.65; 95% CrI 0.28–1.63). Similarly, AS was similar for OL vs. FEEA (RR = 0.46; 95% CrI 0.18–1.28), OL vs. SST (RR = 0.89; 95% CrI 0.39–2.15), OL vs. OrVil® (RR = 0.36; 95% CrI 0.14–1.02), and OL vs. HDST (RR = 0.61; 95% CrI 0.31–1.21). Anastomotic bleeding, time to soft diet resumption, pulmonary complications, hospital length of stay, and mortality were comparable while operative time was reduced for FEEA.

Conclusions

This network meta-analysis shows similar postoperative AL and AS risk when comparing OL, FEEA, SST, HDST, and OrVil® techniques. Similarly, no differences were found for anastomotic bleeding, operative time, soft diet resumption, pulmonary complications, hospital length of stay and 30-day mortality.

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Acknowledgments

The article has been supported by AIRES (Associazione Italiana Ricerca ESofago).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. I.R.C.C.S. Ospedale Galeazzi – Sant’Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy

    Alberto Aiolfi, Andrea Sozzi, Gianluca Bonitta, Francesca Lombardo, Marta Cavalli, Giampiero Campanelli, Luigi Bonavina & Davide Bona

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Correspondence to Alberto Aiolfi.

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Drs Alberto Aiolfi, Andrea Sozzi, Gianluca Bonitta, Francesca Lombardo, Marta Cavalli, Giampiero Campanelli, Luigi Bonavina, and Davide Bona have no conflicts of interest or financial ties to disclose.

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464_2023_10231_MOESM1_ESM.tiff

Supplementary file1 (TIFF 112 KB)— Risk of bias for Randomized Controlled Trials (RCT) was assessed with use of the Cochrane risk-of-bias tool. Green circle: Low risk of Bias. Red circle: High Risk of Bias. Yellow circle: Unclear Risk of Bias.

464_2023_10231_MOESM2_ESM.tiff

Supplementary file2 (TIFF 53 KB)— The Ranking plot applied to the five surgical treatments illustrating the empirical probability that each treatment is ranked 1st through 5th (left to right). The abscissa axis shows the different treatments. The ordinate axis shows the probability (%) of ranking better (higher rankings associated with smaller outcomes values); A: anastomotic leak; B anastomotic stenosis

Supplementary file3 (TIFF 63 KB)

Supplementary file4 (DOCX 19 KB)

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Aiolfi, A., Sozzi, A., Bonitta, G. et al. Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis. Surg Endosc 37, 5777–5790 (2023). https://doi.org/10.1007/s00464-023-10231-6

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