Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4274–4281 | Cite as

Technical Factors that Affect Anastomotic Integrity Following Esophagectomy: Systematic Review and Meta-analysis

  • Sheraz R. Markar
  • Shobhit Arya
  • Alan Karthikesalingam
  • George B. Hanna
Thoracic Oncology

Abstract

Background

Due to the significant contribution of anastomotic leak, with its disastrous consequences to patient morbidity and mortality, multiple parameters have been proposed and individually meta-analyzed for the formation of the ideal esophagogastric anastomosis following cancer resection. The purpose of this pooled analysis was to examine the main technical parameters that impact on anastomotic integrity.

Methods

Medline, Embase, trial registries, and conference proceedings were searched. Technical factors evaluated included hand-sewn versus stapled esophagogastric anastomosis (EGA), cervical versus thoracic EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. The outcome of interest was the incidence of anastomotic leak, for which pooled odds ratios were calculated for each technical factor.

Results

No significant difference in the incidence of anastomotic leak was demonstrated for the following technical factors: hand-sewn versus stapled EGA, minimally invasive versus open esophagectomy, anterior versus posterior route of reconstruction and ischemic conditioning of the gastric conduit. Four randomized, controlled trials comprising 298 patients were included that compared cervical and thoracic EGA. Anastomotic leak was seen more commonly in the cervical group (13.64 %) than in the thoracic group (2.96 %). Pooled analysis demonstrated a significantly increased incidence of anastomotic leak in the cervical group (pooled odds ratio = 4.73; 95 % CI 1.61–13.9; P = 0.005).

Conclusions

A tailored surgical approach to the patient’s physiology and esophageal cancer stage is the most important factor that influences anastomotic integrity after esophagectomy.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Sheraz R. Markar
    • 1
  • Shobhit Arya
    • 1
  • Alan Karthikesalingam
    • 2
  • George B. Hanna
    • 1
  1. 1.Division of Surgery, Department of Surgery and Cancer, St Mary’s HospitalImperial College LondonLondonUK
  2. 2.Department of Outcome Research, St George’s Vascular InstituteSt George’s HospitalLondonUK

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