Cervical or Thoracic Anastomosis after Esophagectomy for Cancer: A Systematic Review and Meta-Analysis

Background: Cervical anastomosis and thoracic anastomosis are used for gastric tube reconstruction after esophagectomy for cancer. This systematic review was conducted in order to identify randomized trials that compare cervical with thoracic anastomosis. Methods: A literature search for randomized trials was performed in the following databases: Medline, Embase and the Cochrane Library. Results: A total of 4 trials were included. All studies had a small sample size and were of moderate quality. One trial was excluded from the meta-analysis. The following outcomes were significantly associated with a cervical anastomosis: recurrent laryngeal nerve trauma (OR: 7.14; 95% CI: 1.75–29.14; p = 0.006) and anastomotic leakage (OR: 3.43; 95% CI: 1.09–10.78; p = 0.03). None of the following outcomes were associated with the location of the anastomosis: pulmonary complications (OR: 0.86; 95% CI: 0.13–5.59; p = 0.87), perioperative mortality (OR: 1.24; 95% CI: 0.35–4.41; p = 0.74), benign stricture formation (OR: 0.79; 95% CI: 0.17–3.87; p = 0.79) or tumor recurrence (OR: 2.01; 95% CI: 0.68–5.91; p = 0.21). Conclusion: Cervical anastomosis could be associated with a higher leak rate and recurrent nerve trauma. However, the currently available ranPublished online: February 4, 2011 S.S.A.Y. Biere, MD Department of Surgery, VU University Medical Center De Boelelaan 1117 NL–1081 HV Amsterdam (The Netherlands) Tel. +31 20 44 44 444, Fax +31 20 44 44 512, E-Mail s.biere @ vumc.nl © 2011 S. Karger AG, Basel 0253–4886/11/0281–0029$38.00/0 Accessible online at: www.karger.com/dsu D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /6 /2 01 7 5: 27 :4 0 A M Biere/Maas/Cuesta/van der Peet Dig Surg 2011;28:29–35 30 and damage to the recurrent laryngeal nerve because of better tumor eradication as well as reduced mortality and morbidity associated with anastomotic breakdown. Several randomized controlled trials (RCTs) have been published in which cervical anastomosis are compared with thoracic anastomosis. To date, no systematic review or meta-analysis of the literature has been performed in order to identify the randomized trials performed in the past and to designate the appropriate anastomotic approach after esophagectomy. This systematic review was conducted in order to identify randomized trials that compare cervical with thoracic anastomosis after esophagectomy for carcinoma. A critical appraisal was performed and shortand long-term outcomes were assessed.