• Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, and Ji-Gang Dai.
• Xu-Feng Deng, Quan-Xing Liu, Dong Zhou, Jia-Xin Min, Ji-Gang Dai, Department of Thoracic Surgery, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
• World J. Gastroenterol. 2015 Apr 21; 21 (15): 4757-64.

AimTo compare the outcomes of hand-sewn (HS) and linearly stapled (LS) esophagogastric anastomosis for esophageal cancer.MethodsBefore beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomized controlled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.ResultsFifteen studies were used, comprising 3203 patients (n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage (RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) associated with LS anastomosis. A significantly reduced rate of anastomotic stricture associated with LS was also found (RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture (P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS (P < 0.00001).ConclusionThis meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.

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