Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Surgeon. 2021 Feb;19(1):37-48. doi: 10.1016/j.surge.2020.01.010. Epub 2020 Mar 21.
The aim of this review was to compare the available treatments of esophageal cancer, in terms of pulmonary, cardiovascular complications, anastomotic leakage, and esophagitis after treatment in patients with esophageal squamous cell carcinoma (SCC).
Medline, Web of Science, Scopus, the Cochrane Library and Embase were searched. The randomized controlled trials (RCT) that had compared the treatment -related complications of treatments for esophageal SCC were included. We included 39 randomized control trials in a network meta-analysis. The Chi2-test was used to assess of heterogeneity. The loop-specific and design-by-treatment interaction methods were used for assessment of consistency assumption. The risk ratio with 95% confidence interval (CI) was used to report the effect-sizes in the network meta-analysis.
The pulmonary complication, cardiac complication, anastomotic leakage, and esophagitis were reported in 31, 11, 17, and 15 RCTs respectively. Video-assisted thoracoscopy + laparoscopy (VATS) was rank as the first and second treatment in terms of lower risk for pulmonary complication and anastomotic leakage. There was no statistically significant difference between treatments in terms of lower risk of cardiovascular complications. However, Surgery + Cisplatin + Fluorouracil (SCF) was ranked as better treatment. 3-dimensional conformal radiotherapy + Docetaxel + Cisplatin (3DCRTDC) was the best treatment in terms of lower risk for esophagitis.
According to the results of this study, it seems the risk of pulmonary, cardiovascular, anastomotic leakage and esophagitis complications for VATS, SCF, surgery + radiotherapy (SRT), and 3DCRTDC was lower than other treatments respectively in the networks.
本综述旨在比较食管鳞癌患者治疗后肺部、心血管并发症、吻合口瘘和食管炎等方面的治疗方法，评估食管鳞癌的治疗效果。
检索 Medline、Web of Science、Scopus、Cochrane 图书馆和 Embase，纳入比较食管鳞癌治疗相关并发症的随机对照试验（RCT）。我们对 39 项随机对照试验进行了网络荟萃分析。采用 Chi2 检验评估异质性。采用环路特异性和治疗设计交互方法评估一致性假设。风险比（RR）及其 95%置信区间（CI）用于报告网络荟萃分析中的效应量。
31 项 RCT 报告了肺部并发症，11 项报告了心脏并发症，17 项报告了吻合口瘘，15 项报告了食管炎。电视辅助胸腔镜手术（VATS）在降低肺部并发症和吻合口瘘风险方面排名第一和第二。在降低心血管并发症风险方面，不同治疗方法之间无统计学差异。然而，手术+顺铂+氟尿嘧啶（SCF）被认为是更好的治疗方法。在降低食管炎风险方面，三维适形放疗+多西紫杉醇+顺铂（3DCRTDC）是最佳治疗方法。
根据本研究结果，在网络中，VATS、SCF、手术+放疗（SRT）和 3DCRTDC 治疗的肺部、心血管、吻合口瘘和食管炎并发症风险似乎低于其他治疗方法。
