Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANGJie ^1,2 , WEIShi-you ² , ZHOUYing ² , YULe ² , GAOQiang ^1,2 ,  CHENLong-qi ^1,2

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

CHENLong-qi, Email: drchenlq@gmail.com

Keywords：

Esophageal cancer; Morbidity; Semi-mechanical anastomosis; Hand-sewn anastomosis; Systematic review

DOI：

10.7507/1007-4848.20140192

Video：

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Objective To investigate the influence of semi-mechanical and hand-sewn esophagogastric anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. Methods A systematic, computer-aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials (RCT)and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. Results Twelve relevant studies with 1 271 patients were included (3 RCTs and 9 observational studies).No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis.There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.34, 95%CI (0.12, 0.97), P < 0.05;observational studies OR=0.40, 95%CI (0.26, 0.62), P < 0.05]. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.14, 95%CI (0.04, 0.47), P < 0.05;observational studies OR=0.22, 95%CI (0.15, 0.34), P < 0.000 1]. Conclusions Compared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anastomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.

Citation： YANGJie, WEIShi-you, ZHOUYing, YULe, GAOQiang, CHENLong-qi. Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 663-669. doi: 10.7507/1007-4848.20140192 Copy

1.	赫捷, 邵康.中國食管癌流行病學現狀、診療現狀及未來對策.中國癌癥雜志, 2011, 21(7):501-504.
2.	楊列, 鄭軼峰, 姜建青, 等.不同食管胃吻合方式對術后并發癥影響的Meta分析.循證醫學, 2013, 13(3):173-180.
3.	Stein HJ, Sendler A, Fink U, et al. Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am, 2000, 80(2):659-682.
4.	Kondra J, Ong SR, Clifton J, et al. A change in clinical practice:a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5):422-429.
5.	全雪梅, 王者生, 王振元, 等.食管癌術后并發癥分析及探討.遼寧醫學雜志, 2009, 23(6):296-298.
6.	劉奎.食管吻合口瘺診療進展.醫學綜述, 2012, 18(8):1191-1194.
7.	張雪飛, 史小男, 韓彪.機械與手工食管胃吻合術后吻合口瘺發生率比較的系統評價.中國循證醫學雜志, 2012, 12(11):1367-1371.
8.	賁曉松, 陳剛, 唐繼鳴, 等.食管-胃頸部側側機械吻合法在三切口食管癌切除術中的應用.中國癌癥雜志, 2010, 20(2):130-133.
9.	胡風標, 鄒志強, 袁耒, 等.半機械側吻合和手工吻合兩種食管胃頸部吻合術式的療效比較.中國現代藥物應用, 2013, 7(14):95-97.
10.	應開軍, 黃利榮, 吳廣洲, 等.三切口食管癌手術頸部半機械側側吻合與手工吻合吻合口并發癥的比較.江蘇醫藥, 2013, 39(19):2333-2335.
11.	Saluja SS, Ray S, Pal S, et al. Randomized trial comparing Side-to-Side stapled and Hand-Sewn esophagogastric anastomosis in neck. J Gastrointest Surg, 2012, 16(7):1287-1295.
12.	楊列, 鄭軼峰, 姜建青, 等.食管癌切除術后頸部食管胃側側吻合與手工端側吻合效果的對照研究.重慶醫學, 2012, 41(30):3155-3156, 3159.
13.	張建國, 于振濤, 任鵬, 等.食管癌切除術后食管胃側側吻合技術的應用現狀.中國腫瘤臨床, 2010, 37(16):958-960.
14.	陳澤鑫, 劉慧, 潘益峰, 等.試驗性和觀察性研究相關醫學文獻質量評價方法.中國循證醫學雜志, 2011, 11(11):1229-1236.
15.	Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5):1805-1813.
16.	Casson AG, Porter GA, Veugelers PJ. Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus, 2002, 15(4):296-302.
17.	Singh D, Maley RH, Santucci T, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg, 2001, 71(2):419-424.
18.	Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5):1043-1050.
19.	Xu QR, Wang KN, Wang WP, et al. Linear stapled esophagogastros-tomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture:a comparative clinical study. J Gastrointest Surg, 2011, 15(6):915-921.
20.	胡為才, 何苡, 侯廣杰, 等.食管癌手術頸部食管-胃吻合3種技術臨床應用分析.中華實用診斷與治療雜志, 2013, 27(10):1034-1035.
21.	黃韜, 洪文娟, 張璟, 等.半機械吻合與手工吻合對食管癌術后頸部吻合口狹窄的影響.中國癌癥雜志, 2012, 22(12):920-923.
22.	龔太乾, 蔣耀光, 王如文, 等.食管癌術后早期并發癥及死亡原因分析.中國胸心血管外科臨床雜志, 2005, 12(3):173-176.
23.	王從容.食管癌術后吻合口瘺原因分析及防治現狀.西部醫學, 2013, 25(7):1118-1119.
24.	Urschel JD, Blewett CJ, Bennett WF, et al. Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer:meta-analysis of randomized controlled trials. Dis Esophagus, 2001, 14(3-4):212-217.
25.	吳云飛, 稅躍平.食管胃機械側側吻合在食管癌及賁門癌治療的臨床應用.吉林醫學, 2011, 32(35):7451-7452.
26.	張永明, 楊文鋒, 李兆敏, 等.食管、管狀胃側側吻合預防食管癌術后吻合口狹窄效果觀察.山東醫藥, 2011, 51(14):48-49.

1. 赫捷, 邵康.中國食管癌流行病學現狀、診療現狀及未來對策.中國癌癥雜志, 2011, 21(7):501-504.
2. 楊列, 鄭軼峰, 姜建青, 等.不同食管胃吻合方式對術后并發癥影響的Meta分析.循證醫學, 2013, 13(3):173-180.
3. Stein HJ, Sendler A, Fink U, et al. Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am, 2000, 80(2):659-682.
4. Kondra J, Ong SR, Clifton J, et al. A change in clinical practice:a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5):422-429.
5. 全雪梅, 王者生, 王振元, 等.食管癌術后并發癥分析及探討.遼寧醫學雜志, 2009, 23(6):296-298.
6. 劉奎.食管吻合口瘺診療進展.醫學綜述, 2012, 18(8):1191-1194.
7. 張雪飛, 史小男, 韓彪.機械與手工食管胃吻合術后吻合口瘺發生率比較的系統評價.中國循證醫學雜志, 2012, 12(11):1367-1371.
8. 賁曉松, 陳剛, 唐繼鳴, 等.食管-胃頸部側側機械吻合法在三切口食管癌切除術中的應用.中國癌癥雜志, 2010, 20(2):130-133.
9. 胡風標, 鄒志強, 袁耒, 等.半機械側吻合和手工吻合兩種食管胃頸部吻合術式的療效比較.中國現代藥物應用, 2013, 7(14):95-97.
10. 應開軍, 黃利榮, 吳廣洲, 等.三切口食管癌手術頸部半機械側側吻合與手工吻合吻合口并發癥的比較.江蘇醫藥, 2013, 39(19):2333-2335.
11. Saluja SS, Ray S, Pal S, et al. Randomized trial comparing Side-to-Side stapled and Hand-Sewn esophagogastric anastomosis in neck. J Gastrointest Surg, 2012, 16(7):1287-1295.
12. 楊列, 鄭軼峰, 姜建青, 等.食管癌切除術后頸部食管胃側側吻合與手工端側吻合效果的對照研究.重慶醫學, 2012, 41(30):3155-3156, 3159.
13. 張建國, 于振濤, 任鵬, 等.食管癌切除術后食管胃側側吻合技術的應用現狀.中國腫瘤臨床, 2010, 37(16):958-960.
14. 陳澤鑫, 劉慧, 潘益峰, 等.試驗性和觀察性研究相關醫學文獻質量評價方法.中國循證醫學雜志, 2011, 11(11):1229-1236.
15. Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5):1805-1813.
16. Casson AG, Porter GA, Veugelers PJ. Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus, 2002, 15(4):296-302.
17. Singh D, Maley RH, Santucci T, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg, 2001, 71(2):419-424.
18. Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5):1043-1050.
19. Xu QR, Wang KN, Wang WP, et al. Linear stapled esophagogastros-tomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture:a comparative clinical study. J Gastrointest Surg, 2011, 15(6):915-921.
20. 胡為才, 何苡, 侯廣杰, 等.食管癌手術頸部食管-胃吻合3種技術臨床應用分析.中華實用診斷與治療雜志, 2013, 27(10):1034-1035.
21. 黃韜, 洪文娟, 張璟, 等.半機械吻合與手工吻合對食管癌術后頸部吻合口狹窄的影響.中國癌癥雜志, 2012, 22(12):920-923.
22. 龔太乾, 蔣耀光, 王如文, 等.食管癌術后早期并發癥及死亡原因分析.中國胸心血管外科臨床雜志, 2005, 12(3):173-176.
23. 王從容.食管癌術后吻合口瘺原因分析及防治現狀.西部醫學, 2013, 25(7):1118-1119.
24. Urschel JD, Blewett CJ, Bennett WF, et al. Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer:meta-analysis of randomized controlled trials. Dis Esophagus, 2001, 14(3-4):212-217.
25. 吳云飛, 稅躍平.食管胃機械側側吻合在食管癌及賁門癌治療的臨床應用.吉林醫學, 2011, 32(35):7451-7452.
26. 張永明, 楊文鋒, 李兆敏, 等.食管、管狀胃側側吻合預防食管癌術后吻合口狹窄效果觀察.山東醫藥, 2011, 51(14):48-49.

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Comparison of Influence of Semi-mechanical and Hand-sewn Esophagogastric Anastomoses on Postoperative Anastomotic Complications:A Systematic Review and Meta-analysis

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