Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4757-4764
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4757
Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: A meta-analysis
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China
Author contributions: Deng XF and Liu QX are co-first authors and contributed equally to this study; Min JX and Dai JG contributed substantially to conception and design of the study; Deng XF, Liu QX and Zhou D contributed to analysis and interpretation of all data and drafted the article; and Deng XF critically revised the article for important intellectual content.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ji-Gang Dai, MD, PhD, Department of Thoracic Surgery, Xinqiao Hospital, The Third Military Medical University, No. 38 Xinqiaozhengjie, Chongqing 400037, China. 691057831@qq.com
Telephone: + 86-23-68774724 Fax: +86-23-68774724
Received: July 25, 2014
Peer-review started: July 28, 2014
First decision: September 15, 2014
Revised: September 30, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: April 21, 2015
Abstract

AIM: To compare the outcomes of hand-sewn (HS) and linearly stapled (LS) esophagogastric anastomosis for esophageal cancer.

METHODS: Before beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomized controlled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.

RESULTS: Fifteen studies were used, comprising 3203 patients (n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage (RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) associated with LS anastomosis. A significantly reduced rate of anastomotic stricture associated with LS was also found (RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture (P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS (P < 0.00001).

CONCLUSION: This meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.

Keywords: Anastomotic leakage, Anastomotic stricture, Hand-sewn anastomosis, Linearly stapled anastomosis, Meta-analysis

Core tip: This is an important meta-analysis comparing the results of hand-sewn and linear stapling techniques for esophagogastric anastomosis after esophageal cancer resection. Primary outcome analysis revealed statistically significant decreases in anastomotic leakage and stricture associated with linearly stapled anastomosis. Subgroup analyses were performed according to site of anastomosis. This meta-analysis may offer some specific suggestions for esophagogastric anastomosis.