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Are intra-operative gastric drainage procedures necessary in esophagectomy: a systematic review and meta-analysis

Lookup NU author(s): Dr Steven Brown, Professor Alexander PhillipsORCiD

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Abstract

© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Surgical pyloroplasty or pyloromyotomy are often performed during esophagectomy with a view of improving gastric conduit drainage. However, the clinical importance of this is not clear, and some centers opt to omit this step. The aim of this meta-analysis is to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention, in patients undergoing esophagectomy with and without a drainage procedure. Methods: A database search of Medline, EMBASE, and Cochrane Library was performed to identify randomized control trials and cohort studies published between 2000 and 2020 which compared outcomes of esophagectomy with and without drainage procedures. A random-effects meta-analysis model was used to compare the rates of pulmonary complications, anastomotic leak, mortality, delayed gastric emptying, and the need for further pyloric intervention. Results: Three randomized and 12 non-randomized publications were identified, comprising a total of 2339 patients. No significant differences were found between the two groups with regard to pulmonary complications (RR 1.02 [95% CI, 0.78–1.33], p = 0.91), anastomotic leak (RR 1.14 [95% CI, 0.80–1.62], p = 0.48), mortality (RR 0.53 [95% CI, 0.23–1.26], p = 0.15), delayed gastric emptying (RR 0.98 [95% CI, 0.59–1.62], p = 0.93), and the need for further pyloric intervention (RR 1.99 [95% CI, 0.56–7.08], p = 0.29). Conclusion: Where post-operative pyloric treatment is available on demand, surgical pyloric drainage procedures may not have any significant clinical impact on patient outcomes for patients undergoing esophagectomy, though further good-quality randomized controlled trials are needed to confirm this.


Publication metadata

Author(s): Nevins EJ, Maleyko I, Brown STR, Nazeer MNM, Sangheli A, Phillips AW

Publication type: Review

Publication status: Published

Journal: Langenbeck's Archives of Surgery

Year: 2022

Volume: 407

Pages: 3287-3295

Print publication date: 01/12/2022

Online publication date: 26/09/2022

Acceptance date: 13/09/2022

ISSN (print): 1435-2443

ISSN (electronic): 1435-2451

Publisher: Springer Science and Business Media Deutschland GmbH

URL: https://doi.org/10.1007/s00423-022-02685-4

DOI: 10.1007/s00423-022-02685-4

PubMed id: 36163378


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