Effect of anastomotic leaks on long-term survival after oesophagectomy for oesophageal cancer: systematic review and meta-analysis.
Dis Esophagus
; 34(3)2021 Mar 08.
Article
em En
| MEDLINE
| ID: mdl-32901259
ABSTRACT
INTRODUCTION:
Long-term survival after curative surgery for oesophageal cancer surgery remains poor, and the prognostic impact of anastomotic leak (AL) remains unknown. A meta-analysis was conducted to investigate the impact of AL on long-term survival.METHODS:
A systematic electronic search for articles was performed for studies published between 2001 and 2020 evaluating the long-term oncological impact of AL. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute hazard ratios and 95% confidence intervals.RESULTS:
Nineteen studies met the inclusion criteria, yielding a total of 9885 patients. Long-term survival was significantly reduced after AL (HR 1.79, 95% CI 1.33-2.43). AL was associated with significantly reduced overall survival in studies within hospital volume Quintile 1 (HR 1.35, 95% CI 1.12-1.63) and Quintile 2 (HR 1.83, 95% CI 1.35-2.47). However, no significant association was found for studies within Quintile 3 (HR 2.24, 95% CI 0.85-5.88), Quintile 4 (HR 2.59, 95% CI 0.67-10.07), and Quintile 5 (HR 1.29, 95% CI 0.92-1.81). AL was significantly associated with poor long-term survival in patients with associated overall Clavien Dindo Grades 1-5 (HR 2.17, 95% CI 1.31-3.59) and severe Clavien Dindo Grades 3-5 (HR 1.42, 95% CI 1.14-1.78) complications.CONCLUSIONS:
AL has a negative prognostic impact on long-term survival after restorative resection of oesophageal cancers, particularly in low-volume centers. Future efforts must be focused on strategies to minimize the septic and immunological response to AL with early recognition and treatment thus reducing the impact on long-term survival.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Esofágicas
/
Esofagectomia
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Dis Esophagus
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Reino Unido