Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

Abstract

Background: Current evidence on the benefits of different anastomotic techniques (hand-sewn (HS), circular stapled (CS), triangulating stapled (TS) or linear stapled/semimechanical (LSSM) techniques) after oesophagectomy is conflicting. The aim of this study was to evaluate the evidence for the techniques for oesophagogastric anastomosis and their impact on perioperative outcomes. Methods: This was a systematic review and network meta-analysis. PubMed, EMBASE and Cochrane Library databases were searched systematically for randomized and non-randomized studies reporting techniques for the oesophagogastric anastomosis. Network meta-analysis of postoperative anastomotic leaks and strictures was performed. Results: Of 4192 articles screened, 15 randomized and 22 non-randomized studies comprising 8618 patients were included. LSSM (odds ratio (OR) 0⋅50, 95 per cent c.i. 0⋅33 to 0⋅74; P = 0⋅001) and CS (OR 0⋅68, 0⋅48 to 0⋅95; P = 0⋅027) anastomoses were associated with lower anastomotic leak rates than HS anastomoses. LSSM anastomoses were associated with lower stricture rates than HS anastomoses (OR 0⋅32, 0⋅19 to 0⋅54; P < 0⋅001). Conclusion: LSSM anastomoses after oesophagectomy are superior with regard to anastomotic leak and stricture rates.

Circular vs. linear stapling after minimally invasive and robotic-assisted esophagectomy: a pooled analysis

“…In open esophagectomy, data concludes that stapling techniques seem to be associated with lower rates of anastomotic leakage in comparison to hand-sewn anastomoses. This was shown in a metanalysis by Kamarajah et al in 2020 which included mostly open esophagectomy and very few trials investigating MIE and robotic-assisted minimally invasive esophagectomy (RAMIE) [ 7 ]. Therefore, analyses towards minimally invasive surgery are still pending.…”

Linear Versus Circular Laparoscopic Gastrojejunal Anastomosis of Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis of 22 Comparative Studies

“…Surprisingly, all studies comparing different surgical techniques for GJ come from bariatric surgery. Recent meta-analyses of various types of esophagogastric anastomosis have shown that LSA is superior with regard to anastomotic leak and stricture rates 34…”

“…Recent meta-analyses of various types of esophagogastric anastomosis have shown that LSA is superior with regard to anastomotic leak and stricture rates. 34 Primary bariatric surgery is a totally laparoscopic field without inflamed or neoplastic tissues; therefore, unbiased evidences can be provided.…”

International consensus statement on robot-assisted minimally invasive esophagectomy (RAMIE)

“…These studies have included both randomized and non-randomized trials, and have found no significant differences in anastomotic leak rates between the two anastomotic techniques (52)(53)(54). A network meta-analysis conducted by Kamarajah (55) demonstrated that stapled anastomosis, including circularand linear-stapled, are associated with lower anastomotic leak rates compared with hand-sewn anastomosis following esophagectomy. Moreover, linear-stapled anastomosis is associated with a lower rate of anastomotic stricture compared with hand-sewn anastomosis.…”