Gastric-tube versus whole-stomach esophagectomy for esophageal cancer: A systematic review and meta-analysis

Wenxiong Zhang, Dongliang Yu, Jinhua Peng, Jianjun Xu, Yiping Wei, Wenxiong Zhang, Dongliang Yu, Jinhua Peng, Jianjun Xu, Yiping Wei

Abstract

Objectives: To conduct a systematic review and meta-analysis of studies comparing the gastric-tube vs. whole-stomach for esophageal cancer in order to determine the optimal surgical technique of esophagectomy.

Methods: A comprehensive literature search was performed using PubMed, EMBASE, ScienceDirect, Ovid MEDLINE, Cochrane Library, Web of Science, Google Scholar, and Scopus. Clinical trials that compared the gastric-tube versus whole-stomach for esophageal cancer were selected. The clinical endpoints included anastomotic leakage, anastomotic stenosis, reflux esophagitis, pneumonia, delayed gastric emptying, and thoracic stomach syndrome.

Results: A total of 6 articles (1571 patients) were included. Compared to the whole-stomach approach, the gastric-tube approach was associated with a lower incidence of reflux esophagitis (95% confidence interval [CI]: 0.16 to 0.81, p = 0.01) and thoracic stomach syndrome (95% CI: 0.17 to 0.55, p < 0.0001). The rates of anastomotic leakage, anastomotic stenosis, pneumonia, and delayed gastric emptying did not significantly differ between the two groups.

Conclusions: The gastric-tube esophagectomy is superior to the whole-stomach approach, as it is associated with a lower incidence of postoperative reflux esophagitis and thoracic stomach syndrome. Our findings must be validated in large-scale randomized controlled trials.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of study selection.
Fig 1. Flow diagram of study selection.
Fig 2. Forest plot of anastomotic leakage…
Fig 2. Forest plot of anastomotic leakage in the whole-stomach and gastric-tube groups.
Fig 3. Forest plot of anastomotic stenosis…
Fig 3. Forest plot of anastomotic stenosis in the whole-stomach and gastric-tube groups.
Fig 4. Forest plot of reflux esophagitis…
Fig 4. Forest plot of reflux esophagitis in the whole-stomach and gastric-tube groups.
Fig 5. Forest plot of pneumonia in…
Fig 5. Forest plot of pneumonia in the whole-stomach and gastric-tube groups.
Fig 6. Forest plot of delayed gastric…
Fig 6. Forest plot of delayed gastric emptying in the whole-stomach and gastric-tube groups.
Fig 7. Forest plot of thoracic stomach…
Fig 7. Forest plot of thoracic stomach syndrome in the whole-stomach and gastric-tube groups.
Fig 8. The Egger test for anastomotic…
Fig 8. The Egger test for anastomotic leakage suggests that no publication bias is present in the pooled analysis.

References

    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61(2): 69–90. 10.3322/caac.20107
    1. Rice TW, Apperson-Hansen C, DiPaola LM, Semple ME, Lerut TE, Orringer MB, et al. Worldwide Esophageal Cancer Collaboration: clinical staging data. Dis Esophagus 2016; 29(7): 707–714. 10.1111/dote.12493
    1. Pauthner M, Haist T, Mann M, Lorenz D. Surgical Therapy of Early Carcinoma of the Esophagus. Viszeralmedizin 2015; 31(5): 326–330. 10.1159/000441049
    1. Best LM, Mughal M, Gurusamy KS. Non-surgical versus surgical treatment for oesophageal cancer. Cochrane Database Syst Rev 2016; 3: CD011498 10.1002/14651858.CD011498.pub2
    1. Rino Y, Yukawa N, Sato T, Yamamoto N, Tamagawa H, Hasegawa S, et al. Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy. BMC Med Imaging 2014; 14: 18 10.1186/1471-2342-14-18
    1. Matsuda T, Kaneda K, Takamatsu M, Takahashi M, Aishin K, Awazu M, et al. Reliable preparation of the gastric tube for cervical esophagogastrostomy after esophagectomy for esophageal cancer. Am J Surg 2010; 199(5): 61–64.
    1. Zhang M, Li Q, Tie HT, Jiang YJ, Wu QC. Methods of reconstruction after esophagectomy on long-term health-related quality of life: a prospective, randomized study of 5-year follow-up. Med Oncol 2015; 32(4): 122 10.1007/s12032-015-0568-0
    1. Li LJ, Wu QC, Zhang C, Zhang M, Qiang L, Jiang YJ, et al. Comparison of long-term health-related quality of life in patients with different methods of reconstruction after oncologic esophagectomy. Zhonghua Yi Xue Za Zhi 2013; 93(35): 2790–2793.
    1. Collard JM, Tinton N, Malaise J, Romagnoli R, Otte JB, Kestens PJ. Esophageal replacement: gastric tube or whole stomach? Ann Thorac Surg 1995; 60(2): 261–267.
    1. Pierie JP, de Graaf PW, van Vroonhoven TJ. The vascularization of a gastric tube as a substitute for the esophagus is affected by its diameter. Dis Esophagus 1998; 11(4): 231–235.
    1. Boyle NH, Pearce A, Hunter D, Owen WJ, Mason RC. Intraoperative scanning laser Doppler flowmetry in the assessment of gastric tube perfusion during esophageal resection. J Am Coll Surg 1999; 188(5): 498–502.
    1. Shu YS, Sun C, Shi WP, Shi HC, Lu SC, Wang K. Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage. Ir J Med Sci 2013; 182(3): 477–480. 10.1007/s11845-013-0917-y
    1. Wells GA, Shea B, O'Connell D, Peterson D, J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. . Accessed 2012.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996; 17(1): 1–12.
    1. Tabira Y, Sakaguchi T, Kuhara H, Teshima K, Tanaka M, Kawasuji M. The width of a gastric tube has no impact on outcome after esophagectomy. Am J Surg 2004; 187(3): 417–421. 10.1016/j.amjsurg.2003.12.008
    1. Li LJ, Wu QC, Zhang C, Zhang M, Qiang L, Jiang YJ, et al. Randomized controlled study of esophagectomy with gastric tube reconstruction versus whole stomach reconstruction for esophageal cancer patients. Chinese Journal of Clinical Oncology 2009; 36(19): 1125–1127, 1131.
    1. Zhang R, Wang P, Zhang X, Zhang L, Li C. Gastric tube reconstruction prevents postoperative recurrence and metastasis of esophageal cancer. Oncol Lett 2011; 11(4): 2507–2509.
    1. Guo W, Ma X, Yang S, Zhu X, Qin W, Xiang J, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc 2016; 30(9): 3873–3881. 10.1007/s00464-015-4692-x
    1. Zhou C, Ma G, Li X, Li J, Yan Y, Liu P, et al. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol 2015; 13: 269 10.1186/s12957-015-0661-z
    1. Djärv T, Lagergren J, Blazeby JM, Lagergren P. Long-term health-related quality of life following surgery for oesophageal cancer. Br J Surg 2008; 95(9): 1121–1126. 10.1002/bjs.6293
    1. Zhang C, Wu QC, Hou PY, Zhang M, Li Q, Jiang YJ, et al. Impact of the method of reconstruction after oncologic oesophagectomy on quality of life—a prospective, randomised study. Eur J Cardio-Thorac, 2011; 39(1): 109–114.
    1. Barbera L, Kemen M, Wegener M, Jergas M, Zumtobel V. Effect of site and width of stomach tube after esophageal resection on gastric emptying. Zentralbl Chir, 1994; 119(4): 240–244.
    1. Bonavina L, Anselmino M, Ruol A, Bardini R, Borsato N, Peracchia A. Functional evaluation of the intrathoracic stomach as an oesophageal substitute. Br J Surg 1992; 79(6): 529–532.
    1. Domergue J, Veyrac M, Huin-Yan S, Rouanet P, Collet H, Michel H, et al. pH monitoring for 24 hours of gastroesophageal reflux and gastric function after intrathoracic gastroplasty after esophagectomy. Surg Gynecol Obstet 1990; 171(2): 107–110.
    1. D'Journo XB, Martin J, Ferraro P, Duranceau A. The esophageal remnant after gastric interposition. Dis Esophagus 2008; 21(5): 377–388. 10.1111/j.1442-2050.2008.00849.x
    1. Chen SW, Fu XN, Xu CC, Zhang N, Pan XJ, Liu MY. Influence of Gastric Tube Reconstruction on Gastroesophageal Reflux after Esophagectomy for Esophageal Carcinoma. Acta Med Univ Med Tongji 2011; 40(5): 593–596.
    1. Panebianco V, Francioni F, Anzidei M, Anile M, Rolla M, Passariello R. Magnetic resonance- fluoroscopy as long-term follow-up examination in patients with narrow gastric tube reconstruction after radical esophagectomy. Eur J Cardiothorac Surg 2006; 30(4): 663–668. 10.1016/j.ejcts.2006.07.007
    1. Korenaga D, Toh Y, Maekawa S, Ikeda T, Sugimachi K. Intra-operative measurement of the tissue blood flow for evaluating blood supply to the gastric tube for esophageal reconstruction. Hepatogastroenterology 1998; 45(24): 2179–2180.
    1. Zhang XF, Shi XN, Han B. Hand-Suture versus Stapling Anastomosis in the Incidence of Anastomotic Leakage Following Esophagogastrostomy: A Systematic Review. Chin J Evid-Based Med 2012; 12(11): 1367–1371.
    1. Lerut TE, van Lanschot JJ. Chronic symptoms after subtotal or partial oesophagectomy: diagnosis and treatment. Best Pract Res Clin Gastroenterol 2004; 18(5): 901–915. 10.1016/j.bpg.2004.06.029

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