Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Eur J Surg Oncol. 2020 Nov;46(11):1975-1988. doi: 10.1016/j.ejso.2020.06.019. Epub 2020 Aug 11.
Leakage of the esophago-gastrostomy after esophagectomy with gastric tube reconstruction is a serious complication. Anastomotic leakage occurs in up to 20% of patients and a compromised perfusion of the gastric tube is thought to play an important role. This meta-analysis aimed to investigate whether arterial calcification is a risk factor for anastomotic leakage in esophageal surgery.
Embase, Medline, PubMed, Cochrane databases and Google scholar databases were systematically searched for studies that assessed arterial calcification of the thoracic aorta, celiac axis including its branches, or the superior mesenteric artery in patients that underwent esophagectomy with gastric tube reconstruction. The degree of calcification was classified as absent, minor or major. A "random-effects model" was used to calculate pooled Odds Ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the Q-test and I-test.
From the 456 articles retrieved, seven studies were selected including 1.860 patients. The median (range) of anastomotic leakage was 17.2% (12.7-24.8). Meta-analysis showed a statistically significant association between increased calcium score and anastomotic leakage for the thoracic aorta (OR 2.18(CI 1.42-3.34)), celiac axis (OR 1.62(CI 1.15-2.29)) and right post-celiac axis (common hepatic, gastroduodenal and right gastroepiploic arteries) (OR 2.69(CI 1.27-5.72)). Heterogeneity was observed for analysis on calcification of the thoracic aorta and celiac axis (I = 71% and 59%, respectively) but not for the right branches of the celiac axis (I = 0%).
This meta-analysis, including good quality studies, showed a statistically significant association between arterial calcification and anastomotic leakage in patients who underwent esophagectomy with gastric tube reconstruction.
食管切除术后胃管重建术后的食管-胃吻合口漏是一种严重的并发症。多达 20%的患者发生吻合口漏，并且认为胃管的灌注受损起着重要作用。本荟萃分析旨在研究动脉钙化是否是食管手术后吻合口漏的危险因素。
系统检索了 Embase、Medline、PubMed、Cochrane 数据库和 Google scholar 数据库中评估接受胃管重建的食管切除术患者的胸主动脉、腹腔干及其分支或肠系膜上动脉的动脉钙化的研究。将钙化程度分为无、轻度或重度。使用“随机效应模型”计算汇总优势比（OR）和 95%置信区间（CI）。使用 Q 检验和 I 检验评估异质性。
从 456 篇文章中，选择了 7 项研究，共纳入 1860 例患者。吻合口漏的中位数（范围）为 17.2%（12.7-24.8）。荟萃分析显示，胸主动脉（OR 2.18[CI 1.42-3.34]）、腹腔干（OR 1.62[CI 1.15-2.29]）和右腹腔干后（肝固有动脉、胃十二指肠动脉和右胃网膜动脉）（OR 2.69[CI 1.27-5.72]）的钙评分增加与吻合口漏之间存在统计学显著关联。观察到分析胸主动脉和腹腔干钙化时存在异质性（I 值分别为 71%和 59%），但腹腔干右支钙化时不存在异质性（I 值为 0%）。
这项荟萃分析包括高质量的研究，表明动脉钙化与接受胃管重建的食管切除术患者的吻合口漏之间存在统计学显著关联。
