BACKGROUND: Cervical anastomosis and thoracic anastomosis are used for gastric tube reconstruction after esophagectomy for cancer. This systematic review was conducted in order to identify randomized trials that compare cervical with thoracic anastomosis. METHODS: A literature search for randomized trials was performed in the following databases: Medline, Embase and the Cochrane Library. RESULTS: A total of 4 trials were included. All studies had a small sample size and were of moderate quality. One trial was excluded from the meta-analysis. The following outcomes were significantly associated with a cervical anastomosis: recurrent laryngeal nerve trauma (OR: 7.14; 95% CI: 1.75-29.14; p = 0.006) and anastomotic leakage (OR: 3.43; 95% CI: 1.09-10.78; p = 0.03). None of the following outcomes were associated with the location of the anastomosis: pulmonary complications (OR: 0.86; 95% CI: 0.13-5.59; p = 0.87), perioperative mortality (OR: 1.24; 95% CI: 0.35-4.41; p = 0.74), benign stricture formation (OR: 0.79; 95% CI: 0.17-3.87; p = 0.79) or tumor recurrence (OR: 2.01; 95% CI: 0.68-5.91; p = 0.21). CONCLUSION: Cervical anastomosis could be associated with a higher leak rate and recurrent nerve trauma. However, the currently available randomized evidence is limited. Further randomized trials are needed to provide sufficient evidence for the preferred location of the anastomosis after esophagectomy.
BACKGROUND: Cervical anastomosis and thoracic anastomosis are used for gastric tube reconstruction after esophagectomy for cancer. This systematic review was conducted in order to identify randomized trials that compare cervical with thoracic anastomosis. METHODS: A literature search for randomized trials was performed in the following databases: Medline, Embase and the Cochrane Library. RESULTS: A total of 4 trials were included. All studies had a small sample size and were of moderate quality. One trial was excluded from the meta-analysis. The following outcomes were significantly associated with a cervical anastomosis: recurrent laryngeal nerve trauma (OR: 7.14; 95% CI: 1.75-29.14; p = 0.006) and anastomotic leakage (OR: 3.43; 95% CI: 1.09-10.78; p = 0.03). None of the following outcomes were associated with the location of the anastomosis: pulmonary complications (OR: 0.86; 95% CI: 0.13-5.59; p = 0.87), perioperative mortality (OR: 1.24; 95% CI: 0.35-4.41; p = 0.74), benign stricture formation (OR: 0.79; 95% CI: 0.17-3.87; p = 0.79) or tumor recurrence (OR: 2.01; 95% CI: 0.68-5.91; p = 0.21). CONCLUSION: Cervical anastomosis could be associated with a higher leak rate and recurrent nerve trauma. However, the currently available randomized evidence is limited. Further randomized trials are needed to provide sufficient evidence for the preferred location of the anastomosis after esophagectomy.
Authors: Sami A Chadi; Abe Fingerhut; Mariana Berho; Steven R DeMeester; James W Fleshman; Neil H Hyman; David A Margolin; Joseph E Martz; Elisabeth C McLemore; Daniela Molena; Martin I Newman; Janice F Rafferty; Bashar Safar; Anthony J Senagore; Oded Zmora; Steven D Wexner Journal: J Gastrointest Surg Date: 2016-09-16 Impact factor: 3.452
Authors: Patrick Heger; Susanne Blank; Markus K Diener; Alexis Ulrich; Thomas Schmidt; Markus W Büchler; André L Mihaljevic Journal: J Gastrointest Surg Date: 2017-04-24 Impact factor: 3.452
Authors: Frans van Workum; Gijs H Berkelmans; Bastiaan R Klarenbeek; Grard A P Nieuwenhuijzen; Misha D P Luyer; Camiel Rosman Journal: J Thorac Dis Date: 2017-07 Impact factor: 2.895