nach oben

Erschienen in:

15.10.2022 | Systematic Review

Linear- versus circular-stapled esophagogastric anastomosis during esophagectomy: systematic review and meta-analysis

verfasst von: Alberto Aiolfi, Andrea Sozzi, Gianluca Bonitta, Francesca Lombardo, Marta Cavalli, Silvia Cirri, Giampiero Campanelli, Piergiorgio Danelli, Davide Bona

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Different techniques have been described for esophagogastric anastomosis. Over the past decades, surgeons have been improving anastomotic techniques with a gradual shift from hand-sewn to stapled anastomosis. Nowadays, circular-stapled (CS) and linear-stapled (LS) anastomosis are commonly used during esophagectomy.

Methods

PubMed, MEDLINE, Scopus, and Web of Science were searched up to June 2022. The included studies evaluated short-term outcomes for LS vs. CS anastomosis in patients undergoing esophagectomy for cancer. Primary outcomes were anastomotic leak (AL) and stricture (AS). Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures whereas 95% confidence intervals (95%CI) were used to assess relative inference.

Results

Eighteen studies (2861 patients) were included. Overall, 1371 (47.9%) underwent CS while 1490 (52.1%) LS. Compared to CS, LS was associated with a significantly reduced RR for AL (RR = 0.70; 95% CI 0.54–0.91; p < 0.01) and AS (RR = 0.32; 95% CI 0.20–0.51; p < 0.0001). Stratified subgroup analysis according to the level of anastomosis (cervical and thoracic) still shows a tendency toward reduced risk for LS. No differences were found for pneumonia (RR 0.78; p = 0.12), reflux esophagitis (RR 0.74; p = 0.36), operative time (SMD −0.25; p = 0.16), hospital length of stay (SMD 0.13; p = 0.51), and 30-day mortality (RR 1.26; p = 0.42).

Conclusions

LS anastomosis seems associated with a tendency toward a reduced risk for AL and AS. Although surgeon’s own training and experience might direct the choice of esophagogastric anastomosis, our meta-analysis encourages the use of LS anastomosis.

Nur mit Berechtigung zugänglich

Murphy G, McCormack V, Abedi-Ardekani B et al (2017) International cancer seminars: a focus on esophageal squamous cell carcinoma. Ann Oncol. 28(9):2086–2093

https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-digestive-system-tumors/esophageal

Kutup A, Nentwich MF, Bollschweiler E et al (2014) What should be the gold standard for the surgical component in the treatment of locally advanced esophageal cancer: transthoracic versus transhiatal esophagectomy. Ann Surg. 260(6):1016–22

Bonavina L (2021) Progress in the esophagogastric anastomosis and the challenges of minimally invasive thoracoscopic surgery. Ann Transl Med. 9(10):907

Goense L, Meziani J, Ruurda JP et al (2019) Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg 106:111–9

Markar S, Gronnier C, Duhamel A et al (2015) The impact of severe anastomotic leak on long-term survival and cancer recurrence after surgical resection for esophageal malignancy. Ann Surg 262:972–80

Shiraishi O, Yasuda T, Kato H et al (2022) Circular stapler method for avoiding stricture of cervical esophagogastric anastomosis. J Gastrointest Surg. 26(4):725–732

Kim RH, Takabe K (2010) Methods of esophagogastric anastomosis following esophagectomy for cancer: a systematic review. J Surg Oncol 101:527–33

Schlottmann F, Angeramo CA, Bras Harriott C et al (2022) Transthoracic esophagectomy: hand-sewn versus side-to-side linear-stapled versus circular-stapled anastomosis: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech. 32(3):380–392

10.

Steichen F (2001) Mechanical sutures in esophageal replacement: fashion or resource? Dis Esophagus 14:1–12

11.

Collard JM, Romagnoli R, Goncette L et al (1998) Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg 65:814–7

12.

Kondra J, Ong SR, Clifton J et al (2008) Change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus. 21(5):422–9

13.

Orringer MB, Marshall B, Iannettoni MD (2000) Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg. 119(2):277–88

14.

Kamarajah SK, Bundred JR, Singh P, Pasquali S, Griffiths EA (2020) Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis. BJS Open. 4(4):563–576

15.

Herron R, Abbas G (2021) Techniques of esophageal anastomoses for esophagectomy. Surg Clin North Am. 101(3):511–524

16.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 339:b2700. https://doi.org/10.1136/bmj.b2700CrossRef

17.

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–12

18.

Goossen K, Tenckhoff S, Probst P et al (2018) Optimal literature search for systematic reviews in surgery. Langenbecks Arch Surg. 403(1):119–129

19.

Sterne JA, Hernan MA, Reeves BC, et al. 2016 ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. i4919:355.

20.

Higgins JP, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

21.

Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 336(7650):924–926

22.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

23.

Porta A, Aiolfi A, Musolino C, Antonini I, Zappa MA (2017) Prospective comparison and quality of life for single-incision and conventional laparoscopic sleeve gastrectomy in a series of morbidly obese patients. Obes Surg 27(3):681–687. https://doi.org/10.1007/s11695-016-2338-2

24.

Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 1(2):97–111

25.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

26.

Aiolfi A, Tornese S, Bonitta G et al (2019) Roux-en-Y gastric bypass: systematic review and Bayesian network meta-analysis comparing open, laparoscopic, and robotic approach. Surg Obes Relat Dis. 15(6):985–994

27.

Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

28.

R Development Core Team (2015) A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna (ISBN 3-900051-07-0)

29.

Furukawa Y, Hanyu N, Hirai K et al (2005) Usefulness of automatic triangular anastomosis for esophageal cancer surgery using a linear stapler (TA-30). Ann Thorac Cardiovasc Surg. 11(2):80–6

30.

Blackmon SH, Correa AM, Wynn B, Hofstetter WL, Martin LW, Mehran RJ, Rice DC, Swisher SG, Walsh GL, Roth JA, Vaporciyan AA (2007) Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg. 83(5):1805–13

31.

Xu QR, Wang KN, Wang WP, Zhang K, Chen LQ (2011) Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study. J Gastrointest Surg. 15(6):915–21

32.

Wang WP, Gao Q, Wang KN, Shi H, Chen LQ (2013) A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg. 37(5):1043–50

33.

Price TN, Nichols FC, Harmsen WS, Allen MS, Cassivi SD, Wigle DA, Shen KR, Deschamps C (2013) A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg. 95(4):1154–60

34.

Li J, Shen Y, Tan L, Feng M, Wang H, Xi Y, Leng Y, Wang Q. Cervical triangulating stapled anastomosis: technique and initial experience. J Thorac Dis. 2014 May;6 Suppl 3(Suppl 3):S350-4.

35.

Mungo B, Lidor AO, Stem M, Molena D (2016) Early experience and lessons learned in a new minimally invasive esophagectomy program. Surg Endosc. 30(4):1692–8

36.

Hayata K, Nakamori M, Nakamura M et al (2017) Circular stapling versus triangulating stapling for the cervical esophagogastric anastomosis after esophagectomy in patients with thoracic esophageal cancer: a prospective, randomized, controlled trial. Surgery. 162(1):131–138

37.

Huang C, Xu X, Zhuang B, Chen W, Xu X, Wang C, Lin S (2017) A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy. World J Surg Oncol. 15(1):31

38.

Yanni F, Singh P, Tewari N, Parsons SL, Catton JA, Duffy J, Welch NT, Vohra RS (2019) Comparison of outcomes with semi-mechanical and circular stapled intrathoracic esophagogastric anastomosis following esophagectomy. World J Surg. 43(10):2483–2489

39.

Schröder W, Raptis DA, Schmidt HM et al (2019) Anastomotic techniques and associated morbidity in total minimally invasive transthoracic esophagectomy: results from the EsoBenchmark database. Ann Surg 270:820–6

40.

Wang ZQ, Jiang YQ, Xu W, Cai HR, Zhang Z, Yin Z, Zhang Q (2018) A novel technique for cervical gastro-oesophageal anastomosis during minimally invasive oesophagectomy. Int J Surg. 53:221–229

41.

Zhang H, Wang Z, Zheng Y, Geng Y, Wang F, Chen LQ, Wang Y (2019) Robotic side-to-side and end-to-side stapled esophagogastric anastomosis of Ivor Lewis esophagectomy for cancer. World J Surg. 43(12):3074–3082

42.

Tian Y, Li L, Li S, Tian H, Lu M (2020) Comparison of circular stapling, triangulating stapling and T-shape stapling for cervical anastomosis with minimally invasive esophagectomy. Ann Transl Med. 8(24):1679

43.

Hirano Y, Fujita T, Sato K, Kurita D, Sato T, Ishiyama K, Fujiwara H, Oguma J, Daiko H (2020) Totally mechanical collard technique for cervical esophagogastric anastomosis reduces stricture formation compared with circular stapled anastomosis. World J Surg. 44(12):4175–4183

44.

Hosoi T, Abe T, Higaki E, Fujieda H, Nagao T, Ito S, Komori K, Iwase M, Oze I, Shimizu Y (2022) Circular stapled technique versus modified collard technique for cervical esophagogastric anastomosis after esophagectomy: a randomized controlled trial. Ann Surg. 276(1):30–37

45.

Sugita H, Sakuramoto S, Oya S, Fujiwara N, Miyawaki Y, Satoh H, Okamoto K, Yamaguchi S, Koyama I (2021) Linear stapler anastomosis for esophagogastrostomy in laparoscopic proximal gastrectomy reduce reflux esophagitis. Langenbecks Arch Surg. 406(8):2709–2716

46.

Fabbi M, van Berge Henegouwen MI, Fumagalli Romario U, Gandini S, Feenstra M, De Pascale S, Gisbertz SS. 2022. End-to-side circular stapled versus side-to-side linear stapled intrathoracic esophagogastric anastomosis following minimally invasive Ivor-Lewis esophagectomy: comparison of short-term outcomes. Langenbecks Arch Surg. https://doi.org/10.1007/s00423-022-02567-9

47.

Oesophago-Gastric Anastomosis Audit study group on behalf of the West Midlands Research Collaborative. 2022 The influence of anastomotic techniques on postoperative anastomotic complications: results of the oesophago-gastric anastomosis audit. J Thorac Cardiovasc Surg. 164(3):674-684.e5.

48.

Griffiths E A, Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative. 2022 Rates of anastomotic complications and their management following esophagectomy: results of the oesophago-gastric anastomosis audit (OGAA). Ann Surg; 275 e382–91.

49.

Derogar M, Orsini N, Sadr-Azodi O, Lagergren P (2012) Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery. J Clin Oncol. 30(14):1615–9

50.

Messager M, Warlaumont M, Renaud F, Marin H, Branche J, Piessen G, Mariette C (2017) Recent improvements in the management of esophageal anastomotic leak after surgery for cancer. Eur J Surg Oncol. 43(2):258–269

51.

Aiolfi A, Asti E, Rausa E, Bonavina G, Bonitta G, Bonavina L (2018) Use of C-reactive protein for the early prediction of anastomotic leak after esophagectomy: systematic review and Bayesian meta-analysis. PLoS One. 13(12):e0209272

52.

Rausa E, Asti E, Aiolfi A, Bianco F, Bonitta G, Bonavina L. 2018 Comparison of endoscopic vacuum therapy versus endoscopic stenting for esophageal leaks: systematic review and meta-analysis. Dis Esophagus. 31(11).

53.

Low DE, Alderson D, Cecconello I et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 262:286–94

54.

Kamarajah SK, Lin A, Tharmaraja T, Bharwada Y, Bundred JR, Nepogodiev D, Evans RPT, Singh P, Griffiths EA. 2020 Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis. Dis Esophagus.;33(3):doz089.

55.

Roos D, Dijksman LM, Tijssen JG et al (2013) Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Br J Surg 100:1579–88

56.

Deng XF, Liu QX, Zhou D, Min JX, Dai JG (2015) Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a meta-analysis. World J Gastroenterol. 21(15):4757–64

57.

Honda M, Kuriyama A, Noma H, Nunobe S, Furukawa TA (2013) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg. 257(2):238–48

58.

Markar SR, Karthikesalingam A, Vyas S, Hashemi M, Winslet M (2011) Hand-sewn versus stapled oesophago-gastric anastomosis: systematic review and meta-analysis. J Gastrointest Surg. 15(5):876–84

59.

Haverkamp L, Seesing MF, Ruurda JP, Boone J, Hillegersberg V, R. (2017) Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus. 30(1):1–7

60.

de Groot EM, Kuiper GM, van der Veen A et al (2022) Indocyanine green fluorescence in robot-assisted minimally invasive esophagectomy with intrathoracic anastomosis: a prospective study. Updates SurgAug. https://doi.org/10.1007/s13304-022-01329-yCrossRef

61.

van Rossum PSN, Haverkamp L, Verkooijen HM et al (2015) Calcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgery. Radiology. 274(1):124–32. https://doi.org/10.1148/radiol.14140410CrossRef

62.

Nickel F, Studier-Fischer A, Özdemir B, et al. 2021 Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging in an experimental model for minimally invasive esophagectomy. bioRxiv .10.03.462901; https://doi.org/10.1101/2021.10.03.462901

63.

Zhou D, Liu QX, Deng XF, Min JX, Dai JG (2015) Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: a meta-analysis. J Cardiothorac Surg. 8(10):67

64.

van Workum F, Stenstra MHBC, Berkelmans GHK et al (2019) Learning curve and associated morbidity of minimally invasive esophagectomy: a retrospective multicenter study. Ann Surg 269:88–94

65.

Markar SR, Mackenzie H, Lagergren P, Hanna GB, Lagergren J (2016) Surgical proficiency gain and survival after esophagectomy for cancer. J Clin Oncol. 34(13):1528–36

66.

Halliday LJ, Doran SLF, Sgromo B, et al. 2020 Variation in esophageal anastomosis technique-the role of collaborative learning. Dis Esophagus;33:doz072.

67.

Tapias LF, Morse CR (2014) Minimally invasive Ivor Lewis esophagectomy: description of a learning curve. J Am Coll Surg. 218(6):1130–40

68.

van Workum F, Stenstra MHBC, Berkelmans GHK, Slaman AE, van Berge Henegouwen MI, Gisbertz SS, van den Wildenberg FJH, Polat F, Irino T, Nilsson M, Nieuwenhuijzen GAP, Luyer MD, Adang EM, Hannink G, Rovers MM, Rosman C (2019) Learning curve and associated morbidity of minimally invasive esophagectomy: a retrospective multicenter study. Ann Surg. 269(1):88–94

69.

Bonavina L, Asti E, Sironi A, Bernardi D, Aiolfi A (2017) Hybrid and total minimally invasive esophagectomy: how I do it. J Thorac Dis. 9(Suppl 8):S761–S772

70.

Ladak F, Dang JT, Switzer N, Mocanu V, Tian C, Birch D, Turner SR, Karmali S (2019) Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis. Surg Endosc. 33(2):384–394

71.

van Boxel G, van Hillegersberg R, Ruurda J (2019) Outcomes and complications after robot-assisted minimally invasive esophagectomy. J Vis Surg 5:21

Titel: Linear- versus circular-stapled esophagogastric anastomosis during esophagectomy: systematic review and meta-analysis
verfasst von: Alberto Aiolfi
Andrea Sozzi
Gianluca Bonitta
Francesca Lombardo
Marta Cavalli
Silvia Cirri
Giampiero Campanelli
Piergiorgio Danelli
Davide Bona
Publikationsdatum: 15.10.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 8/2022
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02706-2

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Linear- versus circular-stapled esophagogastric anastomosis during esophagectomy: systematic review and meta-analysis