Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Dec;407(8):3287-3295.
doi: 10.1007/s00423-022-02685-4. Epub 2022 Sep 26.

Are intra-operative gastric drainage procedures necessary in esophagectomy: a systematic review and meta-analysis

Edward J Nevins  1   2 , Igor Maleyko  3 , Steven Terence Roy Brown  3 , Mohamed Nauzan Mohamed Nazeer  3 , Andrea Sangheli  3 , Alexander W Phillips  4   5
Affiliations
Meta-Analysis

Are intra-operative gastric drainage procedures necessary in esophagectomy: a systematic review and meta-analysis

Edward J Nevins et al. Langenbecks Arch Surg. 2022 Dec.

Abstract

Purpose: Surgical pyloroplasty or pyloromyotomy are often performed during esophagectomy with a view of improving gastric conduit drainage. However, the clinical importance of this is not clear, and some centers opt to omit this step. The aim of this meta-analysis is to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention, in patients undergoing esophagectomy with and without a drainage procedure.

Methods: A database search of Medline, EMBASE, and Cochrane Library was performed to identify randomized control trials and cohort studies published between 2000 and 2020 which compared outcomes of esophagectomy with and without drainage procedures. A random-effects meta-analysis model was used to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention.

Results: Three randomized and 12 non-randomized publications were identified, comprising a total of 2339 patients. No significant differences were found between the two groups with regard to pulmonary complications (RR 1.02 [95% CI, 0.78-1.33], p = 0.91), anastomotic leak (RR 1.14 [95% CI, 0.80-1.62], p = 0.48), mortality (RR 0.53 [95% CI, 0.23-1.26], p = 0.15), delayed gastric emptying (RR 0.98 [95% CI, 0.59-1.62], p = 0.93), and the need for further pyloric intervention (RR 1.99 [95% CI, 0.56-7.08], p = 0.29).

Conclusion: Where post-operative pyloric treatment is available on demand, surgical pyloric drainage procedures may not have any significant clinical impact on patient outcomes for patients undergoing esophagectomy, though further good-quality randomized controlled trials are needed to confirm this.

Keywords: Esophagectomy; Meta-analysis; Pyloric drainage; Pyloromyotomy; Pyloroplasty.

PubMed Disclaimer

Comment in

References

    1. Sinclair RCF, Phillips AW, Navidi M, Griffin SM, Snowden CP (2017) Pre-operative variables including fitness associated with complications after oesophagectomy. Anaesthesia 72(12):1501–1507 - DOI
    1. Cromwell D, Wahedally H, Park MH, Maynard N, Crosy T, Trudgill N et al (2019) National Oesophago-Gastric Cancer Audit. Healthcare Quality Improvement Partnership. [Cited 2021 Dec 19]; Available from: https://www.nogca.org.uk/content/uploads/2019/12/REF150_NOGCA_2019-Annua...
    1. Giugliano DN, Berger AC, Meidl H, Pucci MJ, Rosato EL, Keith SW et al (2017) Do intraoperative pyloric interventions predict the need for postoperative endoscopic interventions after minimally invasive esophagectomy? Dis Esophagus 30(4):1–8 - DOI
    1. Antonoff MB, Puri V, Meyers BF, Baumgartner K, Bell JM, Broderick S et al (2014) Comparison of pyloric intervention strategies at the time of esophagectomy: is more better? Ann Thorac Surg 97(6):1950–1958 - DOI
    1. Lee HS, Moon SK, Jong ML, Seok KK, Kang KW, Jae IZ (2005) Intrathoracic gastric emptying of solid food after esophagectomy for esophageal cancer. Ann Thorac Surg 80(2):443–447 - DOI

LinkOut - more resources