Interventions to prevent anastomotic leak after esophageal surgery: a systematic review and meta-analysis

Abstract Background Anastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review critical appraisal of the efficacy safety all previous interventions aiming reduce AL risk. Methods searched MEDLINE Embase from 1946 January 2019 for randomized controlled trials (RCTs) evaluating minimize esophagogastric AL. Pooled risk ratios (RR) were obtained using random effects model. Results Two reviewers screened 441 abstracts identified 17 RCTs eligible inclusion; 11 studies meta-analyzed. Omentoplasty significantly reduced by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared conventional anastomosis (3 studies, n = 611 patients). Early removal NG tube 62% 0.38; 0.02, 0.65] prolonged (2 293 patients); Stapled did not 0.92; 0.45, 1.87] hand-sewn (6 1454 The quality evidence was high omentoplasty (vs. anastomosis), moderate early removal), very low stapled anastomosis). Conclusions This first meta-analysis summarize graded RCT designed Our findings demonstrated that with evidence. Although risk, there need further research strengthen this finding. Evidence profiles presented in our may help inform development future clinical practice recommendations. Systematic registration: CRD42019127181.