Comparison of safety between manual and mechanical anastomosis of esophageal carcinoma after esophagectomy: A systematic review and meta-analysis
10.7507/1007-4848.201803016
- VernacularTitle:食管癌术后手工吻合和机械吻合安全性比较的系统评价与 Meta 分析
- Author:
ZHU Xiaolei
1
,
2
;
ZHU Zijiang
3
;
WANG Wenhao
3
;
PANG Yao
3
;
TUO Guangxin
1
,
2
Author Information
1. 1. School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China
2. 2. Department 2 of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China
3. Department 2 of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China
- Publication Type:Journal Article
- Keywords:
Esophageal cancer;
mechanical anastomosis;
manual anastomosis;
anastomotic leakage;
anastomotic stenosis;
randomized controlled trial;
systematic review and meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2019;26(5):480-488
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the safety of manual anastomosis and mechanical anastomosis after esophagectomy by meta-analysis. Methods The randomized controlled trials (RCTs) about manual anastomosis and mechanical anastomosis after esophagectomy were searched from PubMed, EMbase and The Cochrane Library from inception to January 2018 by computer, without language restrictions. Two authors according to the inclusion and exclusion criteria independently researched literature, extracted data, evaluated bias risk and used R software meta package for meta-analysis. Results Seventeen RCTs were enrolled, including 2 159 patients (1 230 by manual anastomosis and 1 289 by mechanical anastomosis). The results of meta-analysis showed that: (1) there was no significant difference in the incidence of anastomotic leakage between mechanical and manual anastomosis (RR=1.00, 95%CI 0.67–1.48, P=0.181); (2) no significant difference was found in the 30-day mortality (RR=0.95, 95%CI 0.61–1.49, P=0.631);(3) compared with manual anastomosis, the mechanical anastomosis group may increase the risk of anastomotic stenosis (RR=0.74, 95%CI 0.48-1.14, P<0.001). Conclusion Esophageal cancer surgery using a linear or circular stapler can increase the incidence of anastomotic stenosis after surgery. There is no significant difference in the anastomotic leakage and 30-day mortality between manual anastomosis, linear stapler and circular stapler.
