Esophageal defect repair by artificial scaffolds: a systematic review of experimental studies and proportional meta-analysis

Abstract

Background The traditional technique of gastrointestinal reconstruction of the esophagus after esophagectomy presents plenty of complications. Hence, tissue engineering has been introduced as an effective artificial alternative with potentially fewer complications. Three types of esophageal scaffolds have been used in experimental studies so far. The aim of our meta-analysis is to present the postoperative outcomes after esophageal replacement with artificial scaffolds and the investigation of possible factors that affect these outcomes. Methods The present proportional meta-analysis was designed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and A MeaSurement Tool to Assess systematic Reviews guidelines. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases from inception until February 2020. Results Overall, 32 studies were included that recruited 587 animals. The pooled morbidity after esophageal scaffold implantation was 53.4% (95% CI = 36.6–70.0%). The pooled survival interval was 111.1 days (95% CI = 65.5–156.8 days). Graft stenosis (46%), postoperative dysphagia (15%), and anastomotic leak (12%) were the most common complications after esophageal scaffold implantation. Animals that underwent an implantation of an artificial scaffold in the thoracic part of their esophagus presented higher survival rates than animals that underwent scaffold implantation in the cervical or abdominal part of their esophagus (P < 0.001 and P = 0.011, respectively). Conclusion Tissue engineering seems to offer an effective alternative for the repair of esophageal defects in animal models. Nevertheless, issues like graft stenosis and lack of motility of the esophageal scaffolds need to be addressed in future experimental studies before scaffolds can be tested in human trials.

Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence

“…Although this type of estimate will likely provide lower certainty than if coming from a comparative meta-analysis, it may still be useful to inform decision making particularly in the absence of higher quality evidence, especially in fields such as surgery where randomised controlled trials are rare [ 24 ] (amongst others) (Review Example 3). This principle is true also for pre-clinical studies where investigations may have been performed on a single group in the treatment discovery and testing phase [ 25 , 26 ].…”

Approach to Localized Squamous Cell Cancer of the Esophagus

“…Tissue engineering using artificial scaffolding as an alternative technique for esophageal defect repair is under investigation in animal models. This approach improved survival, but graft stenosis and lack of motility were problematic and may limit use in humans [ 31 ].…”