Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a meta-analysis.
OBJECTIVE
To compare the outcomes of hand-sewn (HS) and linearly stapled (LS) esophagogastric anastomosis for esophageal cancer.


METHODS
Before beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomized controlled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.


RESULTS
Fifteen studies were used, comprising 3203 patients (n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage (RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) associated with LS anastomosis. A significantly reduced rate of anastomotic stricture associated with LS was also found (RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture (P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS (P < 0.00001).


CONCLUSIONS
This meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
Xu-Feng
XF
Deng
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
Quan-Xing
QX
Liu
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
Dong
D
Zhou
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
Jia-Xin
JX
Min
Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
Ji-Gang
JG
Dai
D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016017:Odds Ratio; D065840:Protective Factors; D012307:Risk Factors; D013270:Stomach / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome
Anastomotic leakage; Anastomotic stricture; Hand-sewn anastomosis; Linearly stapled anastomosis; Meta-analysis