Treatment of intrathoracic anastomotic leakage following esophagectomy for gastroesophageal cancer: a systematic review.

IF 2.6 3区 医学 Diseases of the Esophagus Pub Date : 2025-03-03 DOI:10.1093/dote/doaf016
Andreas Weise Mucha, Rune Broni Strandby, Nikolaj Albeck Nerup, Michael Patrick Achiam
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Abstract

Anastomotic leakage (AL) is a significant complication following esophagectomy. AL affects 8%-17% of patients and is associated with increased morbidity, mortality, and hospital stay. To this date, no consensus exists on the most optimal treatment. This systematic review aimed to determine the most effective treatment approach. A systematic search of Medline, Web of Science, Cochrane, Scopus, and Embase databases was conducted. Only studies reporting on the treatment of intrathoracic anastomotic leakage after esophagectomy with gastric conduit reconstruction for cancer were included. Studies investigating other esophageal disorders or failing to report the location of the anastomosis were excluded. The methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale for cohort studies. Out of 12,966 identified studies, 38 were included for analysis after removing duplicates and screening titles, abstracts, and full texts. Of these, five were found to be of poor methodological quality and 33 were of moderate quality. The most researched treatment methods were Endoluminal vacuum therapy (EVT), naso-fistula tube drainage (NFTD), and stent treatment. The success and mortality rates for EVT were 82% and 10.7%, for NFTD, 94% and 5.2%, and, for stent treatment, 75.1% and 13.5%, respectively. AL can be effectively treated with EVT, stent treatment, and NFTD. The NFTD approach appeared to have a higher success rate and lower mortality than other treatment modalities. However, it requires a longer treatment duration. Due to limitations within the included studies, a definitive recommendation regarding the optimal treatment for AL cannot be made.

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吻合口漏(AL)是食管切除术后的一种重要并发症。8%-17%的患者会出现吻合口漏,并且会增加发病率、死亡率和住院时间。迄今为止,人们尚未就最佳治疗方法达成共识。本系统综述旨在确定最有效的治疗方法。我们对 Medline、Web of Science、Cochrane、Scopus 和 Embase 数据库进行了系统检索。只纳入了报告癌症食管切除术后胃导管重建术后胸腔内吻合口漏治疗方法的研究。调查其他食管疾病或未报告吻合口位置的研究被排除在外。研究方法的质量和偏倚风险采用纽卡斯尔-渥太华队列研究量表(Newcastle-Ottawa Scale)进行评估。在 12966 项已确定的研究中,经去除重复研究并筛选标题、摘要和全文后,有 38 项研究被纳入分析范围。其中,5 项研究的方法学质量较差,33 项研究的方法学质量中等。研究最多的治疗方法是腔内真空治疗(EVT)、鼻瘘管引流术(NFTD)和支架治疗。EVT的成功率和死亡率分别为82%和10.7%,NFTD的成功率和死亡率分别为94%和5.2%,支架治疗的成功率和死亡率分别为75.1%和13.5%。EVT、支架治疗和NFTD均可有效治疗AL。与其他治疗方法相比,NFTD方法的成功率更高,死亡率更低。然而,它需要更长的治疗时间。由于所纳入研究的局限性,目前还无法就AL的最佳治疗方法提出明确的建议。
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来源期刊
Diseases of the Esophagus
Diseases of the Esophagus Medicine-Gastroenterology
自引率
7.70%
发文量
568
期刊介绍: Diseases of the Esophagus covers all aspects of the esophagus - etiology, investigation and diagnosis, and both medical and surgical treatment.
期刊最新文献
Reliability of symptoms for diagnosis and sling fiber preservation for prevention of GERD after POEM: is there a problem? Treatment of intrathoracic anastomotic leakage following esophagectomy for gastroesophageal cancer: a systematic review. Causes of death in locally advanced esophageal cancer undergoing neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy: a retrospective cohort study. Letter to the editor: surgical treatment of esophago-tracheobronchial fistulas after esophagectomy. Tribute to Ikuo.
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