BMC Surgery | 2021
Interventions to prevent anastomotic leak after esophageal surgery: a systematic review and meta-analysis
Abstract
Background Anastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review and critical appraisal of\xa0the efficacy and safety of all previous interventions aiming\xa0to reduce AL risk. Methods We searched MEDLINE and Embase from 1946 to January 2019 for randomized controlled trials (RCTs) evaluating interventions to minimize esophagogastric AL. Pooled risk ratios (RR) for AL\xa0were obtained using a\xa0random effects\xa0model. Results Two reviewers screened 441 abstracts and identified 17 RCTs eligible for inclusion; 11 studies were meta-analyzed. Omentoplasty significantly\xa0reduced the risk of AL by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared to\xa0conventional anastomosis (3 studies, n\u2009=\u2009611 patients). Early removal of NG tube\xa0significantly reduced the risk of\xa0AL by 62% [RR: 0.38; 95% CI: 0.02, 0.65] compared to prolonged NG tube\xa0removal (2 studies, n\u2009=\u2009293 patients); Stapled anastomosis did not significantly reduce the risk of\xa0AL [RR: 0.92; 95% CI: 0.45, 1.87] compared to hand-sewn\xa0anastomosis (6 studies, n\u2009=\u20091454 patients). The quality of evidence was high for omentoplasty (vs.\xa0conventional anastomosis), moderate for early NG tube\xa0removal (vs. prolonged NG tube\xa0removal), and very low for stapled anastomosis (vs. hand-sewn\xa0anastomosis). Conclusions This is the first meta-analysis to summarize the graded quality of evidence for all RCT interventions designed to reduce the risk of\xa0AL following esophagectomy. Our findings demonstrated that omentoplasty significantly\xa0reduced the risk of AL with a high quality of evidence. Although early NG tube removal significantly\xa0reduced AL risk, there is a need for further research to strengthen the quality of evidence\xa0for this finding. Evidence profiles presented in our review may help inform the development of future\xa0clinical practice recommendations. Systematic review registration: CRD42019127181.