Medical College, Nantong University, Nantong City, Nantong, 226000, Jiangsu, P.R. China.
Department of Cardiothoracic Surgery, Nanjing Jinling Hospital, East Region Military Command General Hospital, Nanjing, 210000, Jiangsu, P.R. China.
J Cardiothorac Surg. 2023 Aug 9;18(1):242. doi: 10.1186/s13019-023-02309-y.
The choice of anastomosis technique after esophagectomy is closely associated with the postoperative complications. Whether circular stapled or linear stapled anastomosis is the optimal technique has not been established. Therefore, we conducted this meta-analysis to show the latest and most comprehensive published assessment of circular stapled anastomosis in comparison with linear stapled anastomosis in postoperative complications.
Databases (PubMed, Embase, Web of science, Cochrane Library) were searched for all randomized controlled trials and comparative studies comparing circular stapled anastomosis with linear stapled anastomosis after esophagectomy. The odd ratio and mean difference with 95% confidence interval were calculated. We used the Higgins I² statistics to assess the statistical heterogeneity between studies. Review manager (version 5.4) software was used in this analysis.
Sixteen studies with 2322 patients were included in our study. The study demonstrated that the use of linear stapled technique after esophagectomy could reduce the risk of both anastomotic leakage (P = 0.0003) and stricture (P < 0.00001) compared with circular stapled technique. Stratification by anastomotic site showed that no matter what kind of anastomotic site (cervical or thoracic anastomosis) was used, linear stapled anastomosis could effectively reduce the anastomotic stricture in comparison with circular stapled anastomosis. Moreover, linear stapled anastomosis could decrease the risk of thoracic anastomotic leakage. There were no significant differences between circle stapled anastomosis and linear stapled anastomosis in reflux esophagitis (P = 0.17), pneumonia (P = 0.91), operation time (P = 0.41) and hospital stay (P = 0.38).
The study suggested that linear stapled anastomosis could be considered to be an optimal treatment associated with a reduced risk of anastomotic leakage and stricture in comparison with circular stapled anastomosis.
食管切除术后吻合技术的选择与术后并发症密切相关。究竟是使用圆形吻合器吻合还是线性吻合器吻合效果更好，目前尚未确定。因此，我们进行了这项荟萃分析，以展示最新且最全面的关于圆形吻合器与线性吻合器在术后并发症方面的比较评估。
我们检索了PubMed、Embase、Web of science 和 Cochrane Library 等数据库，纳入了所有比较食管切除术后使用圆形吻合器与线性吻合器的随机对照试验和对照研究。计算比值比（OR）和 95%置信区间（CI）的均数差值。我们使用 Higgins I² 统计量评估研究间的统计学异质性。本分析使用 Review Manager（版本 5.4）软件。
我们的研究纳入了 16 项研究，共 2322 例患者。研究表明，与圆形吻合器技术相比，线性吻合器技术可降低术后吻合口漏（P = 0.0003）和吻合口狭窄（P < 0.00001）的风险。根据吻合部位进行分层后发现，无论使用哪种吻合部位（颈部或胸部吻合），与圆形吻合器吻合相比，线性吻合器吻合都可以有效降低吻合口狭窄的风险。此外，线性吻合器吻合可降低胸段吻合口漏的风险。在反流性食管炎（P = 0.17）、肺炎（P = 0.91）、手术时间（P = 0.41）和住院时间（P = 0.38）方面，圆形吻合器吻合与线性吻合器吻合之间没有显著差异。
该研究表明，与圆形吻合器吻合相比，线性吻合器吻合可降低吻合口漏和狭窄的风险，可作为一种更优的治疗选择。
