Transthoracic Esophagectomy: Hand-sewn Versus Side-to-side Linear-stapled Versus Circular-stapled Anastomosis: A Systematic Review and Meta-analysis

Abstract

Background: Three anastomotic techniques are mostly used to create an esophagogastric anastomosis in a transthoracic esophagectomy: hand-sewn (HS), side-to-side linear-stapled (SSLS), and circular-stapled (CS). The aim of this study was to compare surgical outcomes after HS, SSLS, and CS intrathoracic esophagogastric anastomosis. Materials and Methods: A systematic review using the MEDLINE database was performed to identify original articles analyzing outcomes after HS, SSLS, and CS esophagogastric anastomosis. The main outcome was an anastomotic leakage rate. Secondary outcomes included overall morbidity, major morbidity, and mortality. A meta-analysis of proportions and linear regression models were used to assess the effect of each anastomotic technique on the different outcomes. Results: A total of 101 studies comprising 12,595 patients were included; 8835 (70.1%) with CS, 2532 (20.1%) with HS, and 1228 (9.8%) with SSLS anastomosis. Anastomotic leak occurred in 10% [95% confidence interval (CI), 6%-15%], 9% (95% CI, 6%-13%), and 6% (95% CI, 5%-7%) of patients after HS, SSLS, and CS anastomosis, respectively. Risk of anastomotic leakage was significantly higher with HS anastomosis (odds ratio=1.73, 95% CI: 1.47-2.03, P<0.0001) and SSLS (odds ratio=1.68, 95% CI: 1.36-2.08, P<0.0001), as compared with CS. Overall morbidity (HS: 52% vs. SLSS: 39% vs. CS: 35%) and major morbidity (HS: 33% vs. CS: 19%) rates were significantly lower with CS anastomosis. Mortality rate was 4% (95% CI, 3%-6%), 2% (95% CI, 2%-3%), and 3% (95% CI, 3%-4%) after HS, SSLS, and CS anastomosis, respectively. Conclusion: HS and SSLS intrathoracic esophagogastric anastomoses are associated with significantly higher rates of an anastomotic leak than CS anastomosis.

Linear- versus circular-stapled esophagogastric anastomosis during esophagectomy: systematic review and meta-analysis

“…Different techniques have been described for esophagogastric anastomosis such as hand-sewn and mechanical stapled anastomosis [8,9]. Over the past few decades, surgeons have been improving anastomotic techniques with a gradual shift from hand-sewn to stapled anastomosis [10][11][12][13].…”

Blood flow ratio in the gastric conduit measured by laser Doppler flowmetry: A predictor of anastomotic leakage after esophagectomy

“…Anastomotic leakage is a common complication after esophagectomy. The reported incidence of leakage, which can cause postoperative mortality and longer hospital stay lengths, is as high as 31% 1–4 . Therefore, methods to reduce the incidence of this complication are urgently needed to improve the quality of life of patients and reduce postoperative mortality.…”

“…The reported incidence of leakage, which can cause postoperative mortality and longer hospital stay lengths, is as high as 31%. 1 , 2 , 3 , 4 Therefore, methods to reduce the incidence of this complication are urgently needed to improve the quality of life of patients and reduce postoperative mortality. One of the major causes of anastomotic leakage is thought to be reduced blood flow in the gastric conduit.…”