Hand-sewn versus stapled anastomoses for esophagectomy: We will probably never know which is better

Abstract

Abstract Objective Esophagectomy remains the mainstay of treatment for non-metastatic esophageal cancer. The optimal technique for anastomosis after esophagectomy remains unknown. The purpose of this systematic meta-analysis is to combine the available high-quality evidence to provide esophageal surgeons with an evidence base for their decision-making. Method A systematic search of multiple databases was conducted to find randomized controlled trials of esophageal anastomotic techniques. A meta-analysis of the pooled data was conducted. Results A total of 19 studies with 2123 patients were included in the meta-analysis. The pooled analysis revealed a 102% higher incidence of anastomotic leak (AL) after hand-sewn anastomosis compared with stapled anastomosis (OR = 2.02, 95% CI = 1.48-2.75). Anastomotic stricture rate was also 31% higher with hand-sewn anastomosis (OR = 1.31, 95% CI =1.00 - 1.7). 30-day mortality did not show statistical difference favoring one anastomosis technique to another (OR = 0.68, 95% CI = 0.45 – 1.04). Neither AL rate, anastomotic stricture rate nor 30-day OS differed between anastomotic techniques in studies with only thoracic anastomoses. In cervical position hand-sewn anastomosis was associated with higher rate of AL (OR = 2.02, 95% CI = 1.33 – 3.05) and stricture (OR = 1.77, 95% CI = 1.15 – 2.72), but no difference in 30-day mortality. Conclusion This meta-analysis showed a signal of higher rate of leak and stricture in hand-sewn anastomoses, but sensitivity analyses did not show a consistent outcome, so these results should be interpreted with caution.