Keating Muireann, Davey Matthew G, Murray William, Franics Eamon, Donlon Noel E
Department of Plastics and Reconstructive Surgery, St. James's Hospital, Dublin, Republic of Ireland.
Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Dublin, Republic of Ireland.
Ir J Med Sci. 2025 Aug 29. doi: 10.1007/s11845-025-04073-5.
Oesophageal reconstruction is a complex operation that continues to present a surgical challenge associated with significant morbidity and its associated sequelae. The conventional gastric conduit remains the gold standard reconstructive technique when available. Alternative conduits for oesophageal replacement become necessary when the stomach is unavailable with common options for conduit creation being the jejunum and the colon. The aim of this systematic review and network meta-analysis was to interrogate outcomes in oesophageal reconstruction with gastric pull-up, colonic interposition and jejunal flap.
A systematic review of three electronic databases (PubMed, EMBASE and SCOPUS) was undertaken. An NMA as per the PRISMA-NMA guidelines. Statistical analysis was carried out using R and Shiny.
In a total of 19 studies, 3927 patients were included; 79.5% (3123/3927) of patients underwent gastric pull-up; 13.5% (531/3927) of patients underwent colonic interposition; 7% (273/3927) of patients underwent jejunal flap as their reconstructive method. At NMA, there was no significant difference in anastomotic leak rates, mortality rates, stricture formation, necrosis and length of stay between the three reconstructive techniques. Trend results showed jejunal flap performed better than colonic interposition in length of stay and mortality rates.
At present, the gastric conduit is the conventional and first choice for oesophageal reconstruction ab initio after oesophagostomy. Colonic interposition and jejunal free flap represent viable options and are associated with non-inferior short-term surgical outcomes when gastric pull-up is not available or feasible.
食管重建是一项复杂的手术，仍然是一项具有重大发病率及其相关后遗症的手术挑战。当可行时，传统的胃管道仍然是金标准重建技术。当无法使用胃时，替代的食管置换管道就变得必要，常用的管道创建选择是空肠和结肠。本系统评价和网状Meta分析的目的是探讨胃上提术、结肠间置术和空肠瓣在食管重建中的结局。
对三个电子数据库（PubMed、EMBASE和SCOPUS）进行系统评价。按照PRISMA-NMA指南进行网状Meta分析。使用R和Shiny进行统计分析。
总共19项研究纳入了3927例患者；79.5%（3123/3927）的患者接受了胃上提术；13.5%（531/3927）的患者接受了结肠间置术；7%（273/3927）的患者接受了空肠瓣作为重建方法。在网状Meta分析中，三种重建技术在吻合口漏率、死亡率、狭窄形成、坏死和住院时间方面没有显著差异。趋势结果显示，空肠瓣在住院时间和死亡率方面比结肠间置术表现更好。
目前，胃管道是食管造口术后初始食管重建的传统首选。当胃上提术不可行或不可用时，结肠间置术和空肠游离瓣是可行的选择，并且与非劣效的短期手术结局相关。
