Department of General Surgery, University Hospital of Wales, Cardiff, UK.
Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Dis Esophagus. 2023 Oct 27;36(11). doi: 10.1093/dote/doad053.
The aim of this study was to evaluate the effect of intraoperative botulinum toxin (BT) injection on delayed gastric emptying (DGE) and need for endoscopic pyloric intervention (NEPI) following esophagectomy. In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards, a systematic review of studies reporting the outcomes of intraoperative BT injection in patients undergoing esophagectomy for esophageal cancer was conducted. Proportion meta-analysis model was constructed to quantify the risk of the outcomes and direct comparison meta-analysis model was constructed to compare the outcomes between BT injection and no BT injection or surgical pyloroplasty. Meta-regression was modeled to evaluate the effect of variations in different covariates among the individual studies on overall summary proportions. Nine studies enrolling 1070 patients were included. Pooled analyses showed that the risks of DGE and NEPI following intraoperative BT injection were 13.3% (95% confidence interval [CI]: 7.9-18.6%) and 15.2% (95% CI: 7.9-22.5%), respectively. There was no difference between BT injection and no BT injection in terms of DGE (odds ratio [OR]: 0.57, 95% CI: 0.20-1.61, P = 0.29) and NEPI (OR: 1.73, 95% CI: 0.42-7.12, P = 0.45). Moreover, BT injection was comparable to pyloroplasty in terms of DGE (OR: 0.85, 95% CI: 0.35-2.08, P = 0.73) and NEPI (OR: 8.20, 95% CI: 0.63-105.90, P = 0.11). Meta-regression suggested that male gender was negatively associated with the risk of DGE (coefficient: -0.007, P = 0.003). In conclusion, level 2 evidence suggests that intraoperative BT injection may not improve the risk of DGE and NEPI in patients undergoing esophagectomy. The risk of DGE seems to be higher in females and in early postoperative period. High quality randomized controlled trials with robust statistical power are required for definite conclusions. The results of the current study can be used for hypothesis synthesis and power analysis in future prospective trials.
本研究旨在评估术中肉毒杆菌毒素（BT）注射对食管癌患者食管切除术后延迟性胃排空（DGE）和内镜幽门干预（NEPI）的影响。根据系统评价和荟萃分析报告的首选报告项目标准，对报道术中 BT 注射治疗食管癌患者的研究进行了系统评价。采用比例荟萃分析模型量化结局风险，并构建直接比较荟萃分析模型比较 BT 注射与无 BT 注射或手术幽门成形术的结局。采用荟萃回归模型评估个体研究中不同协变量变化对总体汇总比例的影响。共纳入 1070 例患者的 9 项研究。汇总分析显示，术中 BT 注射后 DGE 和 NEPI 的风险分别为 13.3%（95%可信区间[CI]：7.9-18.6%）和 15.2%（95% CI：7.9-22.5%）。BT 注射与无 BT 注射在 DGE（比值比[OR]：0.57，95% CI：0.20-1.61，P=0.29）和 NEPI（OR：1.73，95% CI：0.42-7.12，P=0.45）方面无差异。此外，BT 注射与幽门成形术在 DGE（OR：0.85，95% CI：0.35-2.08，P=0.73）和 NEPI（OR：8.20，95% CI：0.63-105.90，P=0.11）方面相当。荟萃回归提示，男性性别与 DGE 风险呈负相关（系数：-0.007，P=0.003）。总之，证据等级 2 表明，术中 BT 注射可能不会增加食管癌患者术后 DGE 和 NEPI 的风险。女性和术后早期 DGE 风险似乎更高。需要高质量的、具有强大统计学效力的随机对照试验来得出明确的结论。本研究的结果可用于未来前瞻性试验的假设综合和功效分析。
