[Meta-analysis on reconstructions of posterior mediastinal route and anterior mediastinal route after esophagectomy].
OBJECTIVE
To evaluate the efficacy and safety of posterior mediastinal route (PR) as compared with anterior mediastinal route (AR) after esophagectomy.


METHODS
A systematic literature retrieval was carried out to obtain studies of randomized controlled trials (RCT) comparing PR with AR after esophagectomy before June 2012. Study selection, data collections and methodological quality assessments of retrieved studies were independently performed by two individual reviewers and meta-analysis was conducted using the RevMan 5.0 software.


RESULTS
Six RCTs involving 376 patients (PR:197 cases, AR:179 cases) met the selection criteria. Meta-analysis showed that operative mortality (RR=0.49, 95%CI:0.18-1.36), anastomotic leaks (RR=0.95, 95%CI:0.44-2.07), cardiac morbidity (RR=0.51, 95%CI:0.25-1.04), pulmonary morbidity (RR=0.69, 95%CI:0.41-1.15), anastomotic strictures (RR=0.88, 95%CI:0.62-1.25), dysphagia (RR=1.26, 95%CI:0.75-2.11), 6-month body weight after esophagectomy were not significantly different between these two routes of reconstruction (all P>0.05).


CONCLUSIONS
AR should be the choice of reconstruction in view of its potential advantages in the prevention of tumor recurrence within the gastric conduit and avoidance of conduit irradiation when undergoing postoperative radiotherapy. However, further studies are needed to confirm the difference of long-term efficacy between the two routes.
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. drchenlq@gmail.com.
Yu-shang
YS
Yang
Zhong-xi
ZX
Niu
Long-qi
LQ
Chen
D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005763:Gastroenterostomy / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013270:Stomach / Q000601:surgery