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Review
. 2015 Apr 21;21(15):4757-64.
doi: 10.3748/wjg.v21.i15.4757.

Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a meta-analysis

Xu-Feng Deng  1 , Quan-Xing Liu  1 , Dong Zhou  1 , Jia-Xin Min  1 , Ji-Gang Dai  1
Affiliations
Review

Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a meta-analysis

Xu-Feng Deng et al. World J Gastroenterol. .

Abstract

Aim: To compare the outcomes of hand-sewn (HS) and linearly stapled (LS) esophagogastric anastomosis for esophageal cancer.

Methods: Before beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomized controlled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.

Results: Fifteen studies were used, comprising 3203 patients (n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage (RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) associated with LS anastomosis. A significantly reduced rate of anastomotic stricture associated with LS was also found (RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture (P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS (P < 0.00001).

Conclusion: This meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.

Keywords: Anastomotic leakage; Anastomotic stricture; Hand-sewn anastomosis; Linearly stapled anastomosis; Meta-analysis.

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Figures

Figure 1
Figure 1
Flow chart of the literature search according to PRISMA statement. RCTs: Randomized controlled trials.
Figure 2
Figure 2
Forest plot for anastomotic leakage. HS: Hand-sewn; LS: Linearly stapled.
Figure 3
Figure 3
Subgroup analysis for cervical leakage. HS: Hand-sewn; LS: Linearly stapled.
Figure 4
Figure 4
Subgroup analysis for thoracic leakage. HS: Hand-sewn; LS: Linearly stapled.
Figure 5
Figure 5
Forest plot for anastomotic strictures. HS: Hand-sewn; LS: Linearly stapled.
Figure 6
Figure 6
Subgroup analysis for cervical stricture. HS: Hand-sewn; LS: Linearly stapled.
Figure 7
Figure 7
Subgroup analysis for thoracic stricture. HS: Hand-sewn; LS: Linearly stapled.
See this image and copyright information in PMC

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