Stapled vs. hand-sewn anastomosis during esophagectomy: a randomized trials systematic review and meta-analysis.

INTRODUCTION

Esophagogastric anastomosis during esophagectomy is a technically demanding step, carrying a high complication rate. Numerous techniques for anastomosis fashioning have been described, including hand-sewn (HS) and stapled (ST) anastomosis however, the optimal method remains uncertain.

PURPOSE: Analyse short-term outcomes for ST vs. HS anastomosis.

METHODS

Systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. Primary outcomes were anastomotic leak (AL) and stricture (AS).

RESULTS

Twelve RCTs (2015 patients) were included. All trials were deemed to have an intermediate risk of bias. ST anastomosis was performed in 51.9%. The age of the patient population ranged from 37 to 88 years and 73% were males. Squamous cell carcinoma was diagnosed in 76.9% of patients. Neoadjuvant therapy was completed in 32.9%. Ivor-Lewis or McKeown esophagectomy were performed with thoracic (57.2%) or cervical (42.8%) anastomosis. No significant differences were found for ST vs. HS anastomosis for AL (RR 0.97; 95% CI 0.70-1.35) and AS (RR 1.47; 95% CI 0.96-2.23). Further, no differences were found for cardiovascular complications (RR 1.09; p = 0.59), pulmonary complication (RR 1.12; p = 0.28), length of stay (SMD 0.03; p = 0.69), and 30-day mortality (RR 1.30; p = 0.18). Operative time was shorter in ST anastomosis (SMD - 0.11; p = 0.002).

CONCLUSIONS

ST and HS esophagogastric anastomosis yield comparable rates of AL, AS, postoperative complications, and in-hospital mortality. The use of ST anastomosis may result in a shorter operative time. The choice of technique should be determined by the surgeon's expertise and clinical scenario.