Michalinos Adamantios, Antoniou Stavros A, Ntourakis Dimitrios, Schizas Dimitrios, Ekmektzoglou Konstantinos, Angouridis Aris, Johnson Elizabeth O
Department of Anatomy & Surgery, European University of Cyprus, Nicosia, Cyprus.
Department of General Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus.
Dis Esophagus. 2020 Oct 12;33(10). doi: 10.1093/dote/doaa010.
Anastomotic leakage after esophagectomy is a severe and life-threatening complication. Gastric ischemic preconditioning is a strategy for the improvement of anastomotic healing. Aim of this systematic review and meta-analysis is to investigate the impact of gastric ischemic preconditioning on postoperative morbidity. A systematic literature search was performed to identify studies comparing patients undergoing gastric ischemic preconditioning before esophagectomy with nonpreconditioned patients. Meta-analysis was conducted for the overall incidence of anastomotic leakage, severe anastomotic leakage, anastomotic stricture, postoperative morbidity, and mortality. Mantel-Haenszel odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed concerning preconditioning technique, the interval between preconditioning and surgery and the extent of preconditioning. Fifteen cohort studies were identified. Gastric preconditioning was associated with reduced overall incidence of anastomotic leakage (OR 0.73; 95% CI, 0.53-1.0; P = 0.050) and severe anastomotic leakage (OR 0.27; 95% CI, 0.14-0.50; P < 0.010), but not with anastomotic stricture (OR 1.18; 95% CI 0.38 to 3.66; P = 0.780), major postoperative morbidity (OR 1.03; 95% CI 0.45 to 2.36; P = 0.940) or mortality (OR 0.69; 95% CI 0.39 to 1,23; P = 0.210). Subgroup analyses did not identify any differences between embolization and ligation while increasing the interval between preconditioning and esophagectomy as well as the extent of preconditioning might be beneficial. Gastric ischemic preconditioning may be associated with a reduced incidence of overall and severe anastomotic leakage. Randomized studies are necessary to further evaluate its impact on leakage, refine the technique and define patient populations that will benefit the most.
食管癌切除术后吻合口漏是一种严重且危及生命的并发症。胃缺血预处理是一种改善吻合口愈合的策略。本系统评价和荟萃分析的目的是研究胃缺血预处理对术后发病率的影响。进行了系统的文献检索，以确定比较食管癌切除术前接受胃缺血预处理的患者与未接受预处理患者的研究。对吻合口漏、严重吻合口漏、吻合口狭窄、术后发病率和死亡率的总体发生率进行荟萃分析。计算Mantel-Haenszel优势比（OR）和95%置信区间（CI）。对预处理技术、预处理与手术之间的间隔以及预处理程度进行亚组分析。共纳入15项队列研究。胃预处理与吻合口漏总体发生率降低（OR 0.73；95%CI，0.53 - 1.0；P = 0.050）和严重吻合口漏发生率降低（OR 0.27；95%CI，0.14 - 0.50；P < 0.010）相关，但与吻合口狭窄（OR 1.18；95%CI 0.38至3.66；P = 0.780）、术后主要发病率（OR 1.03；95%CI 0.45至2.36；P = 0.940）或死亡率（OR 0.69；95%CI 0.39至1.23；P = 0.210）无关。亚组分析未发现栓塞和结扎之间存在任何差异，而增加预处理与食管癌切除术之间的间隔以及预处理程度可能有益。胃缺血预处理可能与总体和严重吻合口漏发生率降低有关。需要进行随机研究以进一步评估其对漏的影响，完善技术并确定最能从中受益的患者群体。
