Comparison of safety between manual and mechanical anastomosis of esophageal carcinoma after esophagectomy: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Xiaolei ^1,2 ,  ZHU Zijiang ² , WANG Wenhao ² , PANG Yao ² , TUO Guangxin ^1,2

1. School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;
2. Department 2 of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;

Corresponding author：

ZHU Zijiang, Email: zhuzijiang2005@163.com

Keywords：

Esophageal cancer; mechanical anastomosis; manual anastomosis; anastomotic leakage; anastomotic stenosis; randomized controlled trial; systematic review and meta-analysis

DOI：

10.7507/1007-4848.201803016

Video：

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Objective To compare the safety of manual anastomosis and mechanical anastomosis after esophagectomy by meta-analysis. Methods The randomized controlled trials (RCTs) about manual anastomosis and mechanical anastomosis after esophagectomy were searched from PubMed, EMbase and The Cochrane Library from inception to January 2018 by computer, without language restrictions. Two authors according to the inclusion and exclusion criteria independently researched literature, extracted data, evaluated bias risk and used R software meta package for meta-analysis. Results Seventeen RCTs were enrolled, including 2 159 patients (1 230 by manual anastomosis and 1 289 by mechanical anastomosis). The results of meta-analysis showed that: (1) there was no significant difference in the incidence of anastomotic leakage between mechanical and manual anastomosis (RR=1.00, 95%CI 0.67–1.48, P=0.181); (2) no significant difference was found in the 30-day mortality (RR=0.95, 95%CI 0.61–1.49, P=0.631); (3) compared with manual anastomosis, the mechanical anastomosis group may increase the risk of anastomotic stenosis (RR=0.74, 95%CI 0.48-1.14, P<0.001). Conclusion Esophageal cancer surgery using a linear or circular stapler can increase the incidence of anastomotic stenosis after surgery. There is no significant difference in the anastomotic leakage and 30-day mortality between manual anastomosis, linear stapler and circular stapler.

Citation： ZHU Xiaolei, ZHU Zijiang, WANG Wenhao, PANG Yao, TUO Guangxin. Comparison of safety between manual and mechanical anastomosis of esophageal carcinoma after esophagectomy: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(5): 480-488. doi: 10.7507/1007-4848.201803016 Copy

1.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2.	Howlader N, Noone AM, Krapcho M, et al, eds. SEER Cancer Statistics Review, 1975-2011. Bethesda, MD: National Cancer Institute, 2014.
3.	Islami F, Kamangar F, Aghcheli K, et al. Epidemiologic features of upper gastrointestinal tract cancers in Northeastern Iran. Br J Cancer, 2004, 90(7): 1402-1406.
4.	Akiyama Y, Iwaya T, Endo F, et al. Stability of cervical esophagogastrostomy via hand-sewn anastomosis after esophagectomy for esophageal cancer. Dis Esophagus, 2017, 30(5): 1-7.
5.	Collard JM, Romagnoli R, Goncette L, et al. Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg, 1998, 65(3): 814-817.
6.	Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2): 277-288.
7.	Kondra J, Ong SR, Clifton J, et al. A change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5): 422-429.
8.	Singhal S, Kailasam A, Akimoto S, et al. Simple technique of circular stapled anastomosis in Ivor Lewis esophagectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(3): 288-294.
9.	Singh D, Maley RH, Santucci T, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg, 2001, 71(2): 419-424.
10.	Noshiro H, Urata M, Ikeda O, et al. Triangulating stapling technique for esophagogastrostomy after minimally invasive esophagectomy. Surgery, 2013, 154(3): 604-610.
11.	Behzadi A, Nichols FC, Cassivi SD, et al. Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg, 2005, 9(8): 1031-1040.
12.	Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesophagogastric anastomosis: single-centre analysis of 415 oesophagectomies. Eur J Cardiothorac Surg, 2016, 49(6): 1650-1659.
13.	Price TN, Nichols FC, Harmsen WS, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg, 2013, 95(4): 1154-1160.
14.	Toh Y, Sakaguchi Y, Ikeda O, et al. The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today, 2009, 39(3): 201-206.
15.	Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5): 1805-1813.
16.	Liu QX, Qiu Y, Deng XF, et al. Comparison of outcomes following end-to-end hand-sewn and mechanical oesophagogastric anastomosis after oesophagectomy for carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg, 2015, 47(3): e118-e123.
17.	Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai, 2008, 91(5): 681-685.
18.	Zhang YS, Gao BR, Wang HJ, et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer: a prospective randomized controlled trial. J Int Med Res, 2010, 38(1): 227-233.
19.	Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997, 226(2): 169-173.
20.	Deng XF, Liu QX, Zhou D, et al. Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a meta-analysis. World J Gastroenterol, 2015, 21(15): 4757-4764.
21.	Markar SR, Karthikesalingam A, Vyas S, et al. Hand-sewn versus stapled oesophago-gastric anastomosis: systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5): 876-884.
22.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
23.	Higgins JPT. Green S, eds. Cochrane Handbook for SystematicReviews of Interventions, version 5.1.0(updated March 2011).Cochrane Collaboration website. http://training.cochrane.org/handbook.2011. Accessed November 28, 2017.
24.	Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5): 1043-1050.
25.	Saluja SS, Ray S, Pal S, et al. Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck. J Gastrointest Surg, 2012, 16(7): 1287-1295.
26.	Hao SG, Hou XB, Liu P, et al. Investigation and analysis on the life quality of patients by Collard cervical semi-mechanical esophagogastrostomy after esophagectomy. Chin J Cancer Prev Treat, 2015, 13(12): 1050-1054.
27.	West of Scotland and Highland Anastomosis Study Group. Suturing or stapling in gastrointestinal surgery: A prospective randomized study. Br J Surg, 1991, 78(3): 337-341.
28.	Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3): 476-483.
29.	Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb, 1996, 41(1): 17-19.
30.	Laterza E, de' Manzoni G, Veraldi GF, et al. Manual compared with mechanical cervical oesophagogastric anastomosis: a randomised trial. Eur J Surg, 1999, 165(11): 1051-1054.
31.	Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg, 2003, 238(6): 803-812.
32.	Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg, 2004, 25(6): 1097-1101.
33.	Okuyama M, Motoyama S, Suzuki H, et al. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today, 2007, 37(11): 947-952.
34.	Aquino JL, Camargo JG, Said MM, et al. Cervical esophagogastric anastomosis evaluation with a mechanical device versus manual suture in patients with advanced megaesophagus. Rev Col Bras Cir, 2009, 36(1): 19-23.
35.	Ma RD, Zhang WT, Xu QR, et al. Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture: a randomized clinical trial. Zhonghua Wai Ke Za Zhi, 2010, 48(8): 577-581.
36.	Li JY, Wang Y, Liu WL, et al. Comparison between layered anastomosis and mechanical anastomosis of tubular stomach and cervical esophagus in esophagectomy. Chin J Clin Thorac Cardiovasc Surg, 2017, 24(1): 61-64.
37.	Castro PM, Ribeiro FP, Rocha Ade F, et al. Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: systematic review and meta-analysis. Arq Bras Cir Dig, 2014, 27(3): 216-221.
38.	Honda M, Kuriyama A, Noma H, et al. Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg, 2013, 257(2): 238-248.

1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
2. Howlader N, Noone AM, Krapcho M, et al, eds. SEER Cancer Statistics Review, 1975-2011. Bethesda, MD: National Cancer Institute, 2014.
3. Islami F, Kamangar F, Aghcheli K, et al. Epidemiologic features of upper gastrointestinal tract cancers in Northeastern Iran. Br J Cancer, 2004, 90(7): 1402-1406.
4. Akiyama Y, Iwaya T, Endo F, et al. Stability of cervical esophagogastrostomy via hand-sewn anastomosis after esophagectomy for esophageal cancer. Dis Esophagus, 2017, 30(5): 1-7.
5. Collard JM, Romagnoli R, Goncette L, et al. Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg, 1998, 65(3): 814-817.
6. Orringer MB, Marshall B, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2): 277-288.
7. Kondra J, Ong SR, Clifton J, et al. A change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5): 422-429.
8. Singhal S, Kailasam A, Akimoto S, et al. Simple technique of circular stapled anastomosis in Ivor Lewis esophagectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(3): 288-294.
9. Singh D, Maley RH, Santucci T, et al. Experience and technique of stapled mechanical cervical esophagogastric anastomosis. Ann Thorac Surg, 2001, 71(2): 419-424.
10. Noshiro H, Urata M, Ikeda O, et al. Triangulating stapling technique for esophagogastrostomy after minimally invasive esophagectomy. Surgery, 2013, 154(3): 604-610.
11. Behzadi A, Nichols FC, Cassivi SD, et al. Esophagogastrectomy: the influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg, 2005, 9(8): 1031-1040.
12. Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesophagogastric anastomosis: single-centre analysis of 415 oesophagectomies. Eur J Cardiothorac Surg, 2016, 49(6): 1650-1659.
13. Price TN, Nichols FC, Harmsen WS, et al. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg, 2013, 95(4): 1154-1160.
14. Toh Y, Sakaguchi Y, Ikeda O, et al. The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today, 2009, 39(3): 201-206.
15. Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5): 1805-1813.
16. Liu QX, Qiu Y, Deng XF, et al. Comparison of outcomes following end-to-end hand-sewn and mechanical oesophagogastric anastomosis after oesophagectomy for carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg, 2015, 47(3): e118-e123.
17. Luechakiettisak P, Kasetsunthorn S. Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai, 2008, 91(5): 681-685.
18. Zhang YS, Gao BR, Wang HJ, et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer: a prospective randomized controlled trial. J Int Med Res, 2010, 38(1): 227-233.
19. Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997, 226(2): 169-173.
20. Deng XF, Liu QX, Zhou D, et al. Hand-sewn vs linearly stapled esophagogastric anastomosis for esophageal cancer: a meta-analysis. World J Gastroenterol, 2015, 21(15): 4757-4764.
21. Markar SR, Karthikesalingam A, Vyas S, et al. Hand-sewn versus stapled oesophago-gastric anastomosis: systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5): 876-884.
22. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009, 6(7): e1000097.
23. Higgins JPT. Green S, eds. Cochrane Handbook for SystematicReviews of Interventions, version 5.1.0(updated March 2011).Cochrane Collaboration website. http://training.cochrane.org/handbook.2011. Accessed November 28, 2017.
24. Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5): 1043-1050.
25. Saluja SS, Ray S, Pal S, et al. Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck. J Gastrointest Surg, 2012, 16(7): 1287-1295.
26. Hao SG, Hou XB, Liu P, et al. Investigation and analysis on the life quality of patients by Collard cervical semi-mechanical esophagogastrostomy after esophagectomy. Chin J Cancer Prev Treat, 2015, 13(12): 1050-1054.
27. West of Scotland and Highland Anastomosis Study Group. Suturing or stapling in gastrointestinal surgery: A prospective randomized study. Br J Surg, 1991, 78(3): 337-341.
28. Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3): 476-483.
29. Craig SR, Walker WS, Cameron EW, et al. A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb, 1996, 41(1): 17-19.
30. Laterza E, de' Manzoni G, Veraldi GF, et al. Manual compared with mechanical cervical oesophagogastric anastomosis: a randomised trial. Eur J Surg, 1999, 165(11): 1051-1054.
31. Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg, 2003, 238(6): 803-812.
32. Hsu HH, Chen JS, Huang PM, et al. Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg, 2004, 25(6): 1097-1101.
33. Okuyama M, Motoyama S, Suzuki H, et al. Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today, 2007, 37(11): 947-952.
34. Aquino JL, Camargo JG, Said MM, et al. Cervical esophagogastric anastomosis evaluation with a mechanical device versus manual suture in patients with advanced megaesophagus. Rev Col Bras Cir, 2009, 36(1): 19-23.
35. Ma RD, Zhang WT, Xu QR, et al. Esophagogastrostomy by side-to-side anastomosis in prevention of anastomotic stricture: a randomized clinical trial. Zhonghua Wai Ke Za Zhi, 2010, 48(8): 577-581.
36. Li JY, Wang Y, Liu WL, et al. Comparison between layered anastomosis and mechanical anastomosis of tubular stomach and cervical esophagus in esophagectomy. Chin J Clin Thorac Cardiovasc Surg, 2017, 24(1): 61-64.
37. Castro PM, Ribeiro FP, Rocha Ade F, et al. Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: systematic review and meta-analysis. Arq Bras Cir Dig, 2014, 27(3): 216-221.
38. Honda M, Kuriyama A, Noma H, et al. Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg, 2013, 257(2): 238-248.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of safety between manual and mechanical anastomosis of esophageal carcinoma after esophagectomy: A systematic review and meta-analysis

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