Risk factors for esophageal anastomotic stricture after esophagectomy: a meta-analysis.

ABSTRACT

BACKGROUND: The aim of this study was to assess the risk factors for anastomotic stricture in esophageal cancer patients undergoing esophagectomy. Esophageal anastomotic stricture is the most common long-term complication for esophagectomy. The risk factors for esophageal anastomotic stricture still remain controversial. METHODS: MEDLINE, Cochrane Library, and EMBASE were searched to identify observational studies reporting the risk factors for esophageal anastomotic stricture after esophagectomy. A meta-analysis was conducted to investigate the impact of various risk factors on esophageal anastomotic stricture. The GRADE [Grading of Recommendations Assessment, Development and Evaluation] approach was used for quality assessment of evidence on outcome levels. RESULTS: This review included 14 studies evaluating 5987 patients.The meta-analysis found that anastomotic leakage (odds ratio [OR] 2.75; 95% confidence interval[CI]2.16-3.49), cardiovascular disease [OR1.62; 95% CI 1.22-2.16],diabete [OR 1.62; 95% CI 1.20-2.19] may be risk factors for esophageal anastomotic stricture.There were no association between neoadjuvant therapy [OR 0.78; 95% CI0.62-0.97], wide gastric conduit [OR0.98; 95% CI 0.37-2.56],mechanical anastomosis [OR 0.84; 95% CI0.47-1.48],colonic interposition[OR0.20; 95% CI 0.12-0.35],and transhiatal approach[OR1.16; 95% CI0.81-1.64],with the risk of esophageal anastomotic stricture. CONCLUSIONS: This meta-analysis provides some evidence that anastomotic leakage,cardiovascular disease and diabete may be associated with higher rates of esophageal anastomotic stricture.Knowledge about those risk factors may influence treatment and procedure-related decisions,and possibly reduce the anastomotic stricture rate.