Cargando…

A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis

Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high...

Descripción completa

Detalles Bibliográficos
Autores principales: Hung, Pang-Chieh, Chen, Hsuan-Yu, Tu, Yu-Kang, Kao, Yung-Shuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9457433/
https://www.ncbi.nlm.nih.gov/pubmed/36078955
http://dx.doi.org/10.3390/jcm11175025
_version_ 1784786053930942464
author Hung, Pang-Chieh
Chen, Hsuan-Yu
Tu, Yu-Kang
Kao, Yung-Shuo
author_facet Hung, Pang-Chieh
Chen, Hsuan-Yu
Tu, Yu-Kang
Kao, Yung-Shuo
author_sort Hung, Pang-Chieh
collection PubMed
description Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high anastomosis leakage rates among these three types of conduits has not been reported. The aim of this network meta-analysis was to investigate the rate of anastomotic leakage (AL) among the three procedures to determine the best esophageal substitute or the future direction for improving the conventional gastric pull-up (GPU). Methods: We searched PubMed, Cochrane, and Embase databases. We included esophageal cancer patients receiving esophagectomy and excluded patients with other cancer. The random effect model was used in this network meta-analysis. The Newcastle–Ottawa Scale (NOS) was used for the quality assessment of studies in the network meta-analysis, and funnel plots were used to evaluate publication bias. The primary outcome is anastomosis leakage; the secondary outcomes are stricture formation, length of hospital stays, and mortality rate. Results: Nine studies involving 1613 patients were included in this network meta-analysis. The trend results indicated the following. Regarding anastomosis leakage, free jejunal flap was the better procedure; regarding stricture formation, colon interposition was the better procedure; regarding mortality rate, free jejunal flap was the better procedure; regarding length of hospital stay, gastric pull-up was the better treatment. Discussion: Overall, if technically accessible, free jejunal flap is a better choice than colon interposition when gastric conduit cannot be used, but further study should be conducted to compare groups with equal supercharged patients. In addition, jejunal flap (JF) cannot replace traditional gastric pull-up (GPU) due to technical complexities, more anastomotic sites, and longer operation times. However, the GPU method with the supercharged procedure would be a possible solution to lower postoperative AL. The limitation of this meta-analysis is that the number of articles included was low; we aim to update the result when new data are available. Funding: None. Registration: N/A.
format Online
Article
Text
id pubmed-9457433
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-94574332022-09-09 A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis Hung, Pang-Chieh Chen, Hsuan-Yu Tu, Yu-Kang Kao, Yung-Shuo J Clin Med Article Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high anastomosis leakage rates among these three types of conduits has not been reported. The aim of this network meta-analysis was to investigate the rate of anastomotic leakage (AL) among the three procedures to determine the best esophageal substitute or the future direction for improving the conventional gastric pull-up (GPU). Methods: We searched PubMed, Cochrane, and Embase databases. We included esophageal cancer patients receiving esophagectomy and excluded patients with other cancer. The random effect model was used in this network meta-analysis. The Newcastle–Ottawa Scale (NOS) was used for the quality assessment of studies in the network meta-analysis, and funnel plots were used to evaluate publication bias. The primary outcome is anastomosis leakage; the secondary outcomes are stricture formation, length of hospital stays, and mortality rate. Results: Nine studies involving 1613 patients were included in this network meta-analysis. The trend results indicated the following. Regarding anastomosis leakage, free jejunal flap was the better procedure; regarding stricture formation, colon interposition was the better procedure; regarding mortality rate, free jejunal flap was the better procedure; regarding length of hospital stay, gastric pull-up was the better treatment. Discussion: Overall, if technically accessible, free jejunal flap is a better choice than colon interposition when gastric conduit cannot be used, but further study should be conducted to compare groups with equal supercharged patients. In addition, jejunal flap (JF) cannot replace traditional gastric pull-up (GPU) due to technical complexities, more anastomotic sites, and longer operation times. However, the GPU method with the supercharged procedure would be a possible solution to lower postoperative AL. The limitation of this meta-analysis is that the number of articles included was low; we aim to update the result when new data are available. Funding: None. Registration: N/A. MDPI 2022-08-26 /pmc/articles/PMC9457433/ /pubmed/36078955 http://dx.doi.org/10.3390/jcm11175025 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hung, Pang-Chieh
Chen, Hsuan-Yu
Tu, Yu-Kang
Kao, Yung-Shuo
A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
title A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
title_full A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
title_fullStr A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
title_full_unstemmed A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
title_short A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
title_sort comparison of different types of esophageal reconstructions: a systematic review and network meta-analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9457433/
https://www.ncbi.nlm.nih.gov/pubmed/36078955
http://dx.doi.org/10.3390/jcm11175025
work_keys_str_mv AT hungpangchieh acomparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT chenhsuanyu acomparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT tuyukang acomparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT kaoyungshuo acomparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT hungpangchieh comparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT chenhsuanyu comparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT tuyukang comparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis
AT kaoyungshuo comparisonofdifferenttypesofesophagealreconstructionsasystematicreviewandnetworkmetaanalysis