Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy: A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGHang ^1,2 , TUXiang ^1,2 , WEIShi-you ^1,2 , GAOQiang ³ ,  CHENLong-qi ¹

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;
3. Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou 510100, P.R.China;

Corresponding?author：

CHENLong-qi, Email: drchenlq@gmail.com

Keywords：

Esophageal carcinoma; Mechanical anastomosis; Hand-sewn anastomosis; Anastomotic leakage; Anastomotic stenosis; Meta-analysis

DOI：

10.7507/1007-4848.20160142

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Objective To compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. Methods Medline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. Results A total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. Conclusion Mechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.

Citation： ZHANGHang, TUXiang, WEIShi-you, GAOQiang, CHENLong-qi. Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy: A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 595-601. doi: 10.7507/1007-4848.20160142 Copy

1.	陳萬青, 張思維, 曾紅梅, 等. 中國2010年惡性腫瘤發病與死亡. 中國腫瘤, 2014, (01):1-10.
2.	Schweigert M, Dubecz A, Stadlhuber RJ, et al. Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation. Interact Cardiovasc Thorac Surg, 2011, 12(2):147-151.
3.	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.
4.	Suturing or stapling in gastrointestinal surgery:a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg, 1991, 78(3):337-341.
5.	Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb, 1996, 41(1):17-19.
6.	Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma:a controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3):476-483.
7.	Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer-A prospective randomized controlled trial. Ann Surg, 1997, 226(2):169-173.
8.	Laterza E, de' Manzoni G, Veraldi GF, et al. Manual compared with mechanical cervical oesophagogastric anastomosis:a randomised trial. Eur J Surg, 1999, 165(11):1051-1054.
9.	Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstructionA prospective randomized trial comparing sutured neck anastomosis with stapled intrathorocic anastomosis. Ann Surg, 2003, 238(6):803-812.
10.	Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma:a prospective randomized controlled trial. Eur J Cardio-Thorac Surg, 2004, 25(6):1097-1101.
11.	Okuyama M, Motoyama S, Suzuki H, et al. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer:A prospective randomized controlled study. Surg Today, 2007, 37(11):947-952.
12.	Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection:a prospective randomized study. J Med Assoc Thai, 2008, 91(5):681-685.
13.	Aquino JLBd, Said M, Brandi LA, et al. Tubo gástrico isoperistáltico de grande curvatura gástrica com sutura mecanica no tratamento cirúrgico do cancer de es?fago irressecável treatment of non resectable esophageal cancer. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo), 2009, 22(3):147-152.
14.	Zhang YS, Gao BR, Wang HJ, et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer:a prospective randomized controlled trial. J Int Med Res, 2010, 38(1):227-233.
15.	Ma RD, Zhang WT, Xu QR, et al. Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture:a randomized clinical trial. Zhonghua Waide Zaahi, 2010, 48(8):577-581.
16.	Pradeep R, Mishra H, Rao S, et al. Prospective randomized trial comparing hand sewn vs linear stapler esophagogastric anastomosis. J Gastroenterol Hepatol, 2011, 26:201.
17.	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.
18.	Markar SR, Karthikesalingam A, Vyas S, et al. Hand-Sewn versus stapled oesophago-gastric anastomosis:systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5):876-884.
19.	王華, 貢力, 方良偉, 等. 食管癌術后吻合口瘺的原因及預防胃代食管左頸部吻合術后吻合口瘺的原因分析及預防. 局解手術學雜志, 2013, 22(6):685.
20.	韋春暉. 食管癌術后吻合口瘺的預防和治療進展. 現代醫藥衛生, 2010, 18:2779-2781.
21.	林榮繁, 潘越江, 宋建文, 等. 食管癌、賁門癌切除術后食管胃器械吻合術213例臨床觀察. 廣西醫學, 2002, 24(6):796-798.
22.	Vigneswaran WT, Trastek VF, Pairolero PC, et al. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg, 1993, 56(4):838-844.
23.	Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2):277-287.
24.	史素霞. 食管癌術后吻合口狹窄患者的心理護理. 中國醫藥指南, 2014, 12(7):237-238.
25.	馬利明, 高麗艷. 食管癌術后并發癥的臨床分析. 中國藥業, 2013, 22(2):285.
26.	馮世軍, 郭偉, 黃壯士. 頸部器械吻合和手工吻合在食管癌手術中的對比應用. 中國實用醫刊, 2013, 40(3):63-65.
27.	李強,李曉斌. 胸中下段食管癌術后肺部并發癥的臨床研究. 微創醫學, 2012, 7(1):9-12.
28.	劉現民. 56例食管癌、賁門癌術后肺部并發癥的臨床分析. 中國實用醫藥, 2011, 6(4):91-92.

1. 陳萬青, 張思維, 曾紅梅, 等. 中國2010年惡性腫瘤發病與死亡. 中國腫瘤, 2014, (01):1-10.
2. Schweigert M, Dubecz A, Stadlhuber RJ, et al. Treatment of intrathoracic esophageal anastomotic leaks by means of endoscopic stent implantation. Interact Cardiovasc Thorac Surg, 2011, 12(2):147-151.
3. 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.
4. Suturing or stapling in gastrointestinal surgery:a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg, 1991, 78(3):337-341.
5. Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb, 1996, 41(1):17-19.
6. Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma:a controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3):476-483.
7. Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer-A prospective randomized controlled trial. Ann Surg, 1997, 226(2):169-173.
8. Laterza E, de' Manzoni G, Veraldi GF, et al. Manual compared with mechanical cervical oesophagogastric anastomosis:a randomised trial. Eur J Surg, 1999, 165(11):1051-1054.
9. Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstructionA prospective randomized trial comparing sutured neck anastomosis with stapled intrathorocic anastomosis. Ann Surg, 2003, 238(6):803-812.
10. Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma:a prospective randomized controlled trial. Eur J Cardio-Thorac Surg, 2004, 25(6):1097-1101.
11. Okuyama M, Motoyama S, Suzuki H, et al. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer:A prospective randomized controlled study. Surg Today, 2007, 37(11):947-952.
12. Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection:a prospective randomized study. J Med Assoc Thai, 2008, 91(5):681-685.
13. Aquino JLBd, Said M, Brandi LA, et al. Tubo gástrico isoperistáltico de grande curvatura gástrica com sutura mecanica no tratamento cirúrgico do cancer de es?fago irressecável treatment of non resectable esophageal cancer. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo), 2009, 22(3):147-152.
14. Zhang YS, Gao BR, Wang HJ, et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer:a prospective randomized controlled trial. J Int Med Res, 2010, 38(1):227-233.
15. Ma RD, Zhang WT, Xu QR, et al. Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture:a randomized clinical trial. Zhonghua Waide Zaahi, 2010, 48(8):577-581.
16. Pradeep R, Mishra H, Rao S, et al. Prospective randomized trial comparing hand sewn vs linear stapler esophagogastric anastomosis. J Gastroenterol Hepatol, 2011, 26:201.
17. 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.
18. Markar SR, Karthikesalingam A, Vyas S, et al. Hand-Sewn versus stapled oesophago-gastric anastomosis:systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5):876-884.
19. 王華, 貢力, 方良偉, 等. 食管癌術后吻合口瘺的原因及預防胃代食管左頸部吻合術后吻合口瘺的原因分析及預防. 局解手術學雜志, 2013, 22(6):685.
20. 韋春暉. 食管癌術后吻合口瘺的預防和治療進展. 現代醫藥衛生, 2010, 18:2779-2781.
21. 林榮繁, 潘越江, 宋建文, 等. 食管癌、賁門癌切除術后食管胃器械吻合術213例臨床觀察. 廣西醫學, 2002, 24(6):796-798.
22. Vigneswaran WT, Trastek VF, Pairolero PC, et al. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg, 1993, 56(4):838-844.
23. Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2):277-287.
24. 史素霞. 食管癌術后吻合口狹窄患者的心理護理. 中國醫藥指南, 2014, 12(7):237-238.
25. 馬利明, 高麗艷. 食管癌術后并發癥的臨床分析. 中國藥業, 2013, 22(2):285.
26. 馮世軍, 郭偉, 黃壯士. 頸部器械吻合和手工吻合在食管癌手術中的對比應用. 中國實用醫刊, 2013, 40(3):63-65.
27. 李強,李曉斌. 胸中下段食管癌術后肺部并發癥的臨床研究. 微創醫學, 2012, 7(1):9-12.
28. 劉現民. 56例食管癌、賁門癌術后肺部并發癥的臨床分析. 中國實用醫藥, 2011, 6(4):91-92.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Mechanical versus Hand-sewn Anastomosis on Surgical Complications of Patients with Esophageal Carcinoma after Esophagectomy: A Systematic Review and Meta-analysis

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