Outcomes following Oesophagogastric Resections during COVID-19: A Comparative Analysis

Abstract

s European Journal of Surgical Oncology 47 (2021) Introduction: Postoperative atrial fibrillation (AF) after oesophagectomy is associated with pulmonary and anastomotic complications. Landiolol hydrochloride is an ultrashort-acting b1-selective blocker that may prevent AF via its anti-inflammatory and b1-adrenergic blockade effects. We aimed to perform a pilot systematic review, meta-analysis and trial sequential analysis of randomised trials to assess the level of current evidence for hypothesis synthesis. Methods: We conducted a search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register. Results:We identified two placebo-controlled randomised trials, enrolling a total of 139 patients. The included population were comparable in terms of age [67 vs 66, mean difference (MD): 1.32, 95% confidence interval (CI): -1.89, 4.53, P1⁄4 0.42], gender [male: 73% vs 84%, odds ratio (OR): 0.53, 95% CI, 0.23, 1.23, P1⁄4 0.14], hypertension (40% vs 45%, OR: 0.81, 95% CI: 0.41, 1.58. P1⁄40.53), diabetes mellitus (40% vs 45%, OR: 1.28, 95% CI: 0.49, 3.33. P1⁄40.61), intraoperative blood loss (364 ml vs 391 ml, MD: 42.21 95% CI: -9.56, 93.97, P1⁄40.11), and operative time (498min vs 504min, MD: -12.46, 95% CI: -36.57, 11.65, P1⁄40.31). Conclusions: The best available evidence suggests that landiolol hydrochloride is promising in prevention of postoperative AF in patients undergoing oesophagectomy. The available evidence is restricted to a very limited number of RCTs. There is currently no ongoing trial investigating effect of landiolol in postoperative AF following oesophagectomy.