Influence of Two Different Reconstruction Routes on Surgical Outcomes of Patients after Esophagectomy for Esophageal Carcinoma: A Systematic Review and Metaanalysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LONGMeng-yun ^1,2 , WEIShi-you ^1,2 , HUANGQian ¹ , GAOQiang ^1,2 ,  CHENLong-qi ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHENLong-qi, Email: drchenlq@gmail.com

Keywords：

Esophageal carcinoma; Esophageal reconstruction route; Postoperative complications; Systematic review; Meta-analysis

DOI：

10.7507/1007-4848.20150027

Video：

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Objective To systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. Methods A systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis. Results A total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05]. Conclusion For patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.

Citation： LONGMeng-yun, WEIShi-you, HUANGQian, GAOQiang, CHENLong-qi. Influence of Two Different Reconstruction Routes on Surgical Outcomes of Patients after Esophagectomy for Esophageal Carcinoma: A Systematic Review and Metaanalysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 91-99. doi: 10.7507/1007-4848.20150027 Copy

1.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2):69-90.
2.	Altorjay A. Modern esophageal surgery and late functional results as equations with several unknowns——Hungarian Academy of Sciences Doctoral Thesis. Magy Seb, 2008, 61(5):285-296.
3.	Orringer MB, Sloan H. Substernal gastric bypass of the excluded thoracic esophagus for palliation of esophageal carcinoma. J Thorac Cardiovasc Surg, 1975, 70(5):836-851.
4.	方文涛, 陈文虎, 范利民, 等.食管癌切除术后不同重建途径吻合口瘘的原因及预防.中华胃肠外科杂志, 2005, 8(3):217-219.
5.	张志锋, 洪祎纯, 韦武芝, 等.食管癌三切口手术中管状胃两种不同上提径路的临床观察.中华全科医学, 2012, 10(6):875-876.
6.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. J Clin Epidemiol, 2009, 62 (10):1006-1012.
7.	Higgins JPT, Green S, Editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011.
8.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses.[Online] Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.[Accessed 14 December 2013].
9.	Hirai T, Iwata T, Yamashita Y, et al. Investigation of suitability of devascuralized upper half of the whole stomach as replacement for the esophagus. Hiroshima J Med, 1992, 41(2):25-30.
10.	Bartels H, Thorban S, Siewert JR. Anterior versus posterior Reconstruction after transhiatal oesophagectomy:a randomized controlled trial. Br J Surg, 1993, 80(9):1141-1144.
11.	Lee Y, Fujita H, Yamana H, et al. Factors affecting leakage following esophageal anastomosis. Surg Today, 1994, 24(1):24-29.
12.	van Lanschot JJ, van Blankenstein M, Oei HY, et al. Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma. Br J Surg, 1999, 86(1):102-108.
13.	Gawad KA, Hosch SB, Bumann D, et al. How important is the route of reconstruction after esophagectomy:a prospective randomized study. Am J Gastroenterol, 1999, 94(6):1490-1496.
14.	Wong AC, Law S, Wong J. Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer. Dig Surg, 2003, 20(3):209-214.
15.	Khiria LS, Pal S, Peush S, et al. Impact on outcome of the route of conduit transposition after transhiatal oesophagectomy:A randomized controlled trial. Dig Liver Dis, 2009, 41(10):711-716.
16.	Chan ML, Hsieh CC, Wang CW, et al. Reconstruction after esophagectomy for esophageal cancer:retrosternal or posterior mediastinal route? J Chin Med Assoc, 2011, 74(11):505-510.
17.	Wang H, Tan LJ, Feng MX, et al. Comparison of the short-term health-related quality of Life in patients with esophageal cancer with different routes of gastric tube reconstruction after minimally invasive esophagectomy. Qual Life Res, 2011, 20(2):179-189.
18.	Zheng YZ, Dai SQ, Li W, et al. Comparison between different reconstruction routes in esophageal squamous cell carcinoma. World J Gastroenterol, 2012, 18(39):5616-5621.
19.	李学恕, 徐春晖, 袁笑, 等.二种径路食管胃颈部吻合术的比较(附125例报告).中国厂矿医学, 1998, 11(4):5-6.
20.	张珩, 信德和, 段德溥, 等.食管癌放疗后手术方式的效果比较.中国癌症杂志, 2002, 12(2):57-59.
21.	潘开云, 张文山, 郭银枞.中上段食管癌两种三切口术式的临床研究.肿瘤学杂志, 2005, 11(3):210-212.
22.	汪灏, 郑如恒, 冯明祥, 等.胸胃不同上提路径对于三切口食管癌切除术后患者近期生活质量的影响.中国临床医学, 2009, 16(1):70-72.
23.	陈焕文, 杜铭, 吴庆琛, 等.胸腹腔镜食管癌切除术中胸胃采用不同上提路径的对比研究.重庆医科大学学报, 2010, 35(5):788-789.
24.	冯明祥, 王群, 谭黎杰, 等.管状胃在微创食管外科中的应用.中国胸心血管外科临床杂志, 2010, 17(2):92-95.
25.	孔敏, 陈保富, 朱成楚, 等.胸、腹腔镜联合食管癌手术消化道不同重建径路术后疗效的比较.中国微创外科杂志, 2011, 11(12):1082-1085.
26.	乔武.胸腹腔镜食管癌切除术中胸胃采用不同上提路径对患者术后的影响.现代预防医学, 2011, 38(2):366-367.
27.	叶中瑞, 朱成楚, 叶加洪, 等.胸腹腔镜联合食管癌切除术中管状胃两种上提途径的比较.浙江医学, 2012, 33(12):1809-1811.
28.	方忠民, 蓝斌, 朱天翔, 等.经食管床与经胸骨后上提路径行管状胃食管吻合术后患者生活质量的比较研究.中华胃肠外科杂志, 2013, 16(11):1088-1091.
29.	李江红, 刘文亮.食管癌术后吻合口瘘的临床探讨.中国实用医刊, 2013, 40(3):1-3.
30.	Motoyama S, Kitamura M, Saito RA, et al. Surgical outcome of colon interposition by the posterior mediastinal route for thoracic esophageal cancer. Ann Thorac Surg, 2007, 83(4):1273-1278.
31.	Masanobu N, Kato H, Miyazaki T, et al. Comprehensive investigations of quality of life after esophagectomy with special reference to the route of reconstruction. Hepatogastroenterology, 2007, 54(73):104-110.
32.	Hu HC, Yc T, Tan DY, et al. Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study. Eur J Cardio-Thorac Surg, 2011, 40(6):1466-1469.
33.	Coral RP, Constant-Neto M, Silva IS, et al. Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy. Dis Esophagus, 2003, 16(3):236-238.
34.	Hu H, Ye T, Zhang YW, et al. Modifications in retrosternal Reconstruction after oesophagogastrectomy may reduce the incidence of anastomotic leakage. Eur J Cardiothorac Surg, 2012, 42(2):359-363.
35.	Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up:The effect of the route of Reconstruction. World J Surg, 2005, 29(2):174-181.
36.	Nishimura K, Tanaka T, Tanaka Y, et al. Reflux esophagitis and columnar-lined esophagus after cervical esophagogastrostomy (following esophagectomy). Dis Esophagus, 2010, 23(2):94-99.
37.	Mannell A, Mcknight A, Esser JD. Role of pyloroplasty in the retrosternal stomach:results of a prospective, randomized, controlled trial. Br J Surg, 1990, 77(1):57-59.
38.	Makary MA, Kiernan PD, Sheridan MJ, et al. Multimodality treatment for esophageal cancer:the role of surgery and neoadjuvant therapy. Am Surg, 2003, 69(8):700-702.
39.	van Lanschot JJ, Hop WC, Voormolen MH, et al. Quality of palliation and possible benefit of extra-anatomic reconstruction in recurrent dysphagia after resection of carcinoma of the esophagus. J Am Coll Surg, 1994, 179(6):705-713.
40.	欧广飞, 汪楣, 王绿化, 等.食管癌术前放疗后病理反应与预后的关系.中华肿瘤杂志, 2003, 25(3):74-77.

1. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2):69-90.
2. Altorjay A. Modern esophageal surgery and late functional results as equations with several unknowns——Hungarian Academy of Sciences Doctoral Thesis. Magy Seb, 2008, 61(5):285-296.
3. Orringer MB, Sloan H. Substernal gastric bypass of the excluded thoracic esophagus for palliation of esophageal carcinoma. J Thorac Cardiovasc Surg, 1975, 70(5):836-851.
4. 方文涛, 陈文虎, 范利民, 等.食管癌切除术后不同重建途径吻合口瘘的原因及预防.中华胃肠外科杂志, 2005, 8(3):217-219.
5. 张志锋, 洪祎纯, 韦武芝, 等.食管癌三切口手术中管状胃两种不同上提径路的临床观察.中华全科医学, 2012, 10(6):875-876.
6. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. J Clin Epidemiol, 2009, 62 (10):1006-1012.
7. Higgins JPT, Green S, Editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011.
8. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses.[Online] Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.[Accessed 14 December 2013].
9. Hirai T, Iwata T, Yamashita Y, et al. Investigation of suitability of devascuralized upper half of the whole stomach as replacement for the esophagus. Hiroshima J Med, 1992, 41(2):25-30.
10. Bartels H, Thorban S, Siewert JR. Anterior versus posterior Reconstruction after transhiatal oesophagectomy:a randomized controlled trial. Br J Surg, 1993, 80(9):1141-1144.
11. Lee Y, Fujita H, Yamana H, et al. Factors affecting leakage following esophageal anastomosis. Surg Today, 1994, 24(1):24-29.
12. van Lanschot JJ, van Blankenstein M, Oei HY, et al. Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma. Br J Surg, 1999, 86(1):102-108.
13. Gawad KA, Hosch SB, Bumann D, et al. How important is the route of reconstruction after esophagectomy:a prospective randomized study. Am J Gastroenterol, 1999, 94(6):1490-1496.
14. Wong AC, Law S, Wong J. Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer. Dig Surg, 2003, 20(3):209-214.
15. Khiria LS, Pal S, Peush S, et al. Impact on outcome of the route of conduit transposition after transhiatal oesophagectomy:A randomized controlled trial. Dig Liver Dis, 2009, 41(10):711-716.
16. Chan ML, Hsieh CC, Wang CW, et al. Reconstruction after esophagectomy for esophageal cancer:retrosternal or posterior mediastinal route? J Chin Med Assoc, 2011, 74(11):505-510.
17. Wang H, Tan LJ, Feng MX, et al. Comparison of the short-term health-related quality of Life in patients with esophageal cancer with different routes of gastric tube reconstruction after minimally invasive esophagectomy. Qual Life Res, 2011, 20(2):179-189.
18. Zheng YZ, Dai SQ, Li W, et al. Comparison between different reconstruction routes in esophageal squamous cell carcinoma. World J Gastroenterol, 2012, 18(39):5616-5621.
19. 李学恕, 徐春晖, 袁笑, 等.二种径路食管胃颈部吻合术的比较(附125例报告).中国厂矿医学, 1998, 11(4):5-6.
20. 张珩, 信德和, 段德溥, 等.食管癌放疗后手术方式的效果比较.中国癌症杂志, 2002, 12(2):57-59.
21. 潘开云, 张文山, 郭银枞.中上段食管癌两种三切口术式的临床研究.肿瘤学杂志, 2005, 11(3):210-212.
22. 汪灏, 郑如恒, 冯明祥, 等.胸胃不同上提路径对于三切口食管癌切除术后患者近期生活质量的影响.中国临床医学, 2009, 16(1):70-72.
23. 陈焕文, 杜铭, 吴庆琛, 等.胸腹腔镜食管癌切除术中胸胃采用不同上提路径的对比研究.重庆医科大学学报, 2010, 35(5):788-789.
24. 冯明祥, 王群, 谭黎杰, 等.管状胃在微创食管外科中的应用.中国胸心血管外科临床杂志, 2010, 17(2):92-95.
25. 孔敏, 陈保富, 朱成楚, 等.胸、腹腔镜联合食管癌手术消化道不同重建径路术后疗效的比较.中国微创外科杂志, 2011, 11(12):1082-1085.
26. 乔武.胸腹腔镜食管癌切除术中胸胃采用不同上提路径对患者术后的影响.现代预防医学, 2011, 38(2):366-367.
27. 叶中瑞, 朱成楚, 叶加洪, 等.胸腹腔镜联合食管癌切除术中管状胃两种上提途径的比较.浙江医学, 2012, 33(12):1809-1811.
28. 方忠民, 蓝斌, 朱天翔, 等.经食管床与经胸骨后上提路径行管状胃食管吻合术后患者生活质量的比较研究.中华胃肠外科杂志, 2013, 16(11):1088-1091.
29. 李江红, 刘文亮.食管癌术后吻合口瘘的临床探讨.中国实用医刊, 2013, 40(3):1-3.
30. Motoyama S, Kitamura M, Saito RA, et al. Surgical outcome of colon interposition by the posterior mediastinal route for thoracic esophageal cancer. Ann Thorac Surg, 2007, 83(4):1273-1278.
31. Masanobu N, Kato H, Miyazaki T, et al. Comprehensive investigations of quality of life after esophagectomy with special reference to the route of reconstruction. Hepatogastroenterology, 2007, 54(73):104-110.
32. Hu HC, Yc T, Tan DY, et al. Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study. Eur J Cardio-Thorac Surg, 2011, 40(6):1466-1469.
33. Coral RP, Constant-Neto M, Silva IS, et al. Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy. Dis Esophagus, 2003, 16(3):236-238.
34. Hu H, Ye T, Zhang YW, et al. Modifications in retrosternal Reconstruction after oesophagogastrectomy may reduce the incidence of anastomotic leakage. Eur J Cardiothorac Surg, 2012, 42(2):359-363.
35. Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up:The effect of the route of Reconstruction. World J Surg, 2005, 29(2):174-181.
36. Nishimura K, Tanaka T, Tanaka Y, et al. Reflux esophagitis and columnar-lined esophagus after cervical esophagogastrostomy (following esophagectomy). Dis Esophagus, 2010, 23(2):94-99.
37. Mannell A, Mcknight A, Esser JD. Role of pyloroplasty in the retrosternal stomach:results of a prospective, randomized, controlled trial. Br J Surg, 1990, 77(1):57-59.
38. Makary MA, Kiernan PD, Sheridan MJ, et al. Multimodality treatment for esophageal cancer:the role of surgery and neoadjuvant therapy. Am Surg, 2003, 69(8):700-702.
39. van Lanschot JJ, Hop WC, Voormolen MH, et al. Quality of palliation and possible benefit of extra-anatomic reconstruction in recurrent dysphagia after resection of carcinoma of the esophagus. J Am Coll Surg, 1994, 179(6):705-713.
40. 欧广飞, 汪楣, 王绿化, 等.食管癌术前放疗后病理反应与预后的关系.中华肿瘤杂志, 2003, 25(3):74-77.

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Influence of Two Different Reconstruction Routes on Surgical Outcomes of Patients after Esophagectomy for Esophageal Carcinoma: A Systematic Review and Metaanalysis

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