Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milan, Italy.
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA.
J Laparoendosc Adv Surg Tech A. 2023 Jun;33(6):524-533. doi: 10.1089/lap.2023.0004. Epub 2023 Apr 13.
While numerous techniques have been defined for esophagojejunostomy (EJ) during total gastrectomy including hand-sewn and stapled anastomoses, mechanical linear-stapled (LS) and circular-stapled (CS) anastomoses are widely adopted. However, there are scarce data on the optimal stapled technique for EJ during total gastrectomy. Scopus, Web of Science, MEDLINE, and PubMed were investigated up to October 30, 2022. We considered articles that appraised short-term outcomes after LS versus CS anastomosis in patients undergoing total gastrectomy for gastric cancer. Anastomotic leak (AL), anastomotic stricture (AS), and anastomotic bleeding (AB) were primary outcomes. Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures, whereas 95% confidence intervals (95% CIs) were used to calculate related inference. Sixteen studies (3156 patients) were incorporated. Overall, 1540 (48.8%) underwent CS, whereas 1616 (51.2%) underwent LS. Compared with CS, LS was related to a condensed RR for AS (RR: 0.27; 95% CI 0.15-0.49; < .01), whereas no differences were found for AL (RR: 0.75; 95% CI 0.51-1.10; = .14) and AB (RR: 0.59; 95% CI 0.24-1.44; = .25). Postoperative pneumonia (RR: 0.98; = .94), operative time (SMD: 0.51; = .31), days to soft diet (SMD: -0.08; = .36), hospital stay (SMD: 0.19; = .46), and 30-day mortality (RR: 1.76; = .31) were comparable between LS and CS. For EJ during total gastrectomy, our results suggest that LS seems related to a reduced risk of AS compared with CS, although no significant differences were found for the risk of AL and AB between the two techniques. Clinical Trial Registration number: CRD42022381221.
在全胃切除术中，食管空肠吻合术（EJ）有许多技术被定义，包括手工缝合和吻合器吻合，机械线性吻合（LS）和圆形吻合（CS）吻合被广泛采用。然而，关于全胃切除术中 EJ 的最佳吻合技术的数据很少。截至 2022 年 10 月 30 日，我们检索了 Scopus、Web of Science、MEDLINE 和 PubMed。我们考虑了评估 LS 与 CS 吻合术治疗胃癌全胃切除术后短期结局的文章。吻合口漏（AL）、吻合口狭窄（AS）和吻合口出血（AB）是主要结局。风险比（RR）和标准化均数差（SMD）被用作汇总效应量的指标，而 95%置信区间（95%CI）用于计算相关推断。纳入了 16 项研究（3156 例患者）。总的来说，1540 例（48.8%）患者接受 CS 治疗，1616 例（51.2%）患者接受 LS 治疗。与 CS 相比，LS 与 AS 的 RR 降低有关（RR：0.27；95%CI 0.15-0.49； < .01），而 AL（RR：0.75；95%CI 0.51-1.10； = .14）和 AB（RR：0.59；95%CI 0.24-1.44； = .25）之间无差异。术后肺炎（RR：0.98； = .94）、手术时间（SMD：0.51； = .31）、软食时间（SMD：-0.08； = .36）、住院时间（SMD：0.19； = .46）和 30 天死亡率（RR：1.76； = .31）在 LS 和 CS 之间相似。对于全胃切除术中的 EJ，我们的结果表明，与 CS 相比，LS 似乎与 AS 风险降低有关，尽管两种技术之间 AL 和 AB 的风险无显著差异。临床试验注册号：CRD42022381221。
