Alberto Aiolfi1, Emanuele Asti1, Gianluca Bonitta1, Luigi Bonavina2. 1. Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Piazza Edmondo Malan, 1, 20097, San Donato Milanese, MI, Italy. 2. Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Piazza Edmondo Malan, 1, 20097, San Donato Milanese, MI, Italy. luigi.bonavina@unimi.it.
Abstract
BACKGROUND: Indications for surgery and clinical outcomes of esophagectomy in the management of end-stage achalasia are not clearly defined. The aim of this systematic review and meta-analysis was to provide evidence-based information to help in the decision-making and in the choice of surgical technique. METHODS: An extensive literature search was conducted to identify all reports on esophagectomy for end-stage achalasia patients over the past three decades. MEDLINE, Embase and Cochrane databases were thoroughly consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy" and "esophageal resection" with "AND" and "OR." Short- and long-term outcome data were extracted. Pooled prevalence of pneumonia, anastomotic leakage and mortality were calculated using Freeman-Tukey double arcsine transformation and DerSimonian-Laird estimator in random effect meta-analysis. Heterogeneity among studies was evaluated using I 2-index and Cochrane Q test. Meta-regression was used to address the effect of potential confounders. RESULTS: Eight papers published between 1989 and 2014 matched the inclusion criteria. In total, 1307 patients were included. Esophagectomy was performed through a transthoracic (78.7%) or a transhiatal (21.3%) approach. The stomach was used as an esophageal substitute in 95% of patients. Pooled prevalence of pneumonia, anastomotic leakage and mortality were 10% (95% CI 4-18%), 7% (95% CI 4-10%) and 2% (95% CI 1-3%), respectively. CONCLUSIONS: Esophagectomy for end-stage achalasia is safe and effective. Based on the results of this study, esophagectomy should be performed without hesitation in patients who are fit for major surgery and present with disabling symptoms, poor quality of life and dolichomegaesophagus recalcitrant to multiple endoscopic dilatations and/or surgical myotomies.
BACKGROUND: Indications for surgery and clinical outcomes of esophagectomy in the management of end-stage achalasia are not clearly defined. The aim of this systematic review and meta-analysis was to provide evidence-based information to help in the decision-making and in the choice of surgical technique. METHODS: An extensive literature search was conducted to identify all reports on esophagectomy for end-stage achalasiapatients over the past three decades. MEDLINE, Embase and Cochrane databases were thoroughly consulted matching the terms "achalasia," "end-stage achalasia," "esophagectomy" and "esophageal resection" with "AND" and "OR." Short- and long-term outcome data were extracted. Pooled prevalence of pneumonia, anastomotic leakage and mortality were calculated using Freeman-Tukey double arcsine transformation and DerSimonian-Laird estimator in random effect meta-analysis. Heterogeneity among studies was evaluated using I 2-index and Cochrane Q test. Meta-regression was used to address the effect of potential confounders. RESULTS: Eight papers published between 1989 and 2014 matched the inclusion criteria. In total, 1307 patients were included. Esophagectomy was performed through a transthoracic (78.7%) or a transhiatal (21.3%) approach. The stomach was used as an esophageal substitute in 95% of patients. Pooled prevalence of pneumonia, anastomotic leakage and mortality were 10% (95% CI 4-18%), 7% (95% CI 4-10%) and 2% (95% CI 1-3%), respectively. CONCLUSIONS: Esophagectomy for end-stage achalasia is safe and effective. Based on the results of this study, esophagectomy should be performed without hesitation in patients who are fit for major surgery and present with disabling symptoms, poor quality of life and dolichomegaesophagus recalcitrant to multiple endoscopic dilatations and/or surgical myotomies.
Authors: Guilherme M Campos; Eric Vittinghoff; Charlotte Rabl; Mark Takata; Michael Gadenstätter; Feng Lin; Ruxandra Ciovica Journal: Ann Surg Date: 2009-01 Impact factor: 12.969
Authors: R A B Oude Nijhuis; G Zaninotto; S Roman; G E Boeckxstaens; P Fockens; M W Langendam; A A Plumb; Ajpm Smout; E M Targarona; A S Trukhmanov; Blam Weusten; Albert J Bredenoord Journal: United European Gastroenterol J Date: 2020-02 Impact factor: 4.623