Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Medical Technology

Background:

• Conflicting evidence exists regarding the optimal anastomotic technique following esophagectomy.
• Key techniques include hand-sewn (HS), circular stapled (CS), triangulating stapled (TS), and linear stapled/semimechanical (LSSM).
• Evaluating these techniques is crucial for improving perioperative outcomes in esophageal cancer patients.

Purpose of the Study:

• To systematically review and compare the efficacy of different anastomotic techniques after esophagectomy.
• To evaluate the impact of these techniques on critical perioperative outcomes, specifically anastomotic leaks and strictures.

Main Methods:

• A systematic review and network meta-analysis was conducted.
• Searched major databases (PubMed, EMBASE, Cochrane Library) for relevant randomized and non-randomized studies.
• Performed network meta-analysis to compare anastomotic leak and stricture rates across techniques.

Main Results:

• Included 15 randomized and 22 non-randomized studies involving 8618 patients.
• Linear stapled/semimechanical (LSSM) and circular stapled (CS) anastomoses showed significantly lower anastomotic leak rates than hand-sewn (HS) techniques.
• LSSM anastomoses demonstrated significantly lower stricture rates compared to HS anastomoses.

Conclusions:

• Linear stapled/semimechanical (LSSM) anastomoses are superior to hand-sewn techniques in reducing both anastomotic leak and stricture rates after esophagectomy.
• The findings suggest LSSM as a preferred method for achieving better outcomes in esophageal surgery.