Different types of oesophageal reconstructions in the contemporary era: a systematic review and network meta-analysis

Oesophageal reconstruction is a complex operation that continues to present a surgical challenge associated with significant morbidity and its associated sequelae. The conventional gastric conduit remains the gold standard reconstructive technique when available. Alternative conduits for oesophageal replacement become necessary when the stomach is unavailable with common options for conduit creation being the jejunum and the colon. The aim of this systematic review and network meta-analysis was to interrogate outcomes in oesophageal reconstruction with gastric pull-up, colonic interposition and jejunal flap.

A systematic review of three electronic databases (PubMed, EMBASE and SCOPUS) was undertaken. An NMA as per the PRISMA-NMA guidelines. Statistical analysis was carried out using R and Shiny.

In a total of 19 studies, 3927 patients were included; 79.5% (3123/3927) of patients underwent gastric pull-up; 13.5% (531/3927) of patients underwent colonic interposition; 7% (273/3927) of patients underwent jejunal flap as their reconstructive method. At NMA, there was no significant difference in anastomotic leak rates, mortality rates, stricture formation, necrosis and length of stay between the three reconstructive techniques. Trend results showed jejunal flap performed better than colonic interposition in length of stay and mortality rates.

At present, the gastric conduit is the conventional and first choice for oesophageal reconstruction ab initio after oesophagostomy. Colonic interposition and jejunal free flap represent viable options and are associated with non-inferior short-term surgical outcomes when gastric pull-up is not available or feasible.