Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Isabel Lopes Dias Azevedo
Data de Publicação: 2021
Tipo de documento: Dissertação
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://hdl.handle.net/10216/139777
Resumo: Background and objectives: Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. AL can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting) or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare a) endoscopic and surgical interventions and b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three on-line databases (MEDLINE, ISI Web of Knowledge and Scopus) for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1080 patients were included. Compared with surgical intervention, endoscopic treatment was associated with lower in-hospital mortality (35.8% [95% CI 23.9-48.5%] versus 6.4% [95% CI 3.8-9.6%]), although clinical success, hospital length of stay and intensive care unit (ICU) length of stay were similar in both groups. Compared with stenting, endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI 0.127-0.954]) and shorter ICU length of stay (mean difference -14.77 days [95% CI -26.57 to -2.98]) and time until AL resolution (17.6 days [95% CI 14.1-21.2] versus 39.4 days [95% CI 27.0-51.8]). There were no significant differences in terms of clinical success, mortality, reinterventions, and hospital length of stay. Conclusions: Endoscopic treatment (in comparison to surgical intervention) and endoscopic vacuum therapy (in comparison to stenting) are safer and more effective. However, more robust comparative studies are needed to confirm these benefits.
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spelling Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysisMedicina clínicaClinical medicineBackground and objectives: Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. AL can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting) or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare a) endoscopic and surgical interventions and b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three on-line databases (MEDLINE, ISI Web of Knowledge and Scopus) for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1080 patients were included. Compared with surgical intervention, endoscopic treatment was associated with lower in-hospital mortality (35.8% [95% CI 23.9-48.5%] versus 6.4% [95% CI 3.8-9.6%]), although clinical success, hospital length of stay and intensive care unit (ICU) length of stay were similar in both groups. Compared with stenting, endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI 0.127-0.954]) and shorter ICU length of stay (mean difference -14.77 days [95% CI -26.57 to -2.98]) and time until AL resolution (17.6 days [95% CI 14.1-21.2] versus 39.4 days [95% CI 27.0-51.8]). There were no significant differences in terms of clinical success, mortality, reinterventions, and hospital length of stay. Conclusions: Endoscopic treatment (in comparison to surgical intervention) and endoscopic vacuum therapy (in comparison to stenting) are safer and more effective. However, more robust comparative studies are needed to confirm these benefits.2021-07-012021-07-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttps://hdl.handle.net/10216/139777TID:203177819engIsabel Lopes Dias Azevedoinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-29T15:58:58Zoai:repositorio-aberto.up.pt:10216/139777Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T00:36:08.680028Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
title Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
spellingShingle Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
Isabel Lopes Dias Azevedo
Medicina clínica
Clinical medicine
title_short Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
title_full Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
title_fullStr Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
title_full_unstemmed Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
title_sort Endoscopic and surgical management of anastomotic leakages following gastroesophageal cancer surgery: a systematic review and meta-analysis
author Isabel Lopes Dias Azevedo
author_facet Isabel Lopes Dias Azevedo
author_role author
dc.contributor.author.fl_str_mv Isabel Lopes Dias Azevedo
dc.subject.por.fl_str_mv Medicina clínica
Clinical medicine
topic Medicina clínica
Clinical medicine
description Background and objectives: Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. AL can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting) or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare a) endoscopic and surgical interventions and b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three on-line databases (MEDLINE, ISI Web of Knowledge and Scopus) for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1080 patients were included. Compared with surgical intervention, endoscopic treatment was associated with lower in-hospital mortality (35.8% [95% CI 23.9-48.5%] versus 6.4% [95% CI 3.8-9.6%]), although clinical success, hospital length of stay and intensive care unit (ICU) length of stay were similar in both groups. Compared with stenting, endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI 0.127-0.954]) and shorter ICU length of stay (mean difference -14.77 days [95% CI -26.57 to -2.98]) and time until AL resolution (17.6 days [95% CI 14.1-21.2] versus 39.4 days [95% CI 27.0-51.8]). There were no significant differences in terms of clinical success, mortality, reinterventions, and hospital length of stay. Conclusions: Endoscopic treatment (in comparison to surgical intervention) and endoscopic vacuum therapy (in comparison to stenting) are safer and more effective. However, more robust comparative studies are needed to confirm these benefits.
publishDate 2021
dc.date.none.fl_str_mv 2021-07-01
2021-07-01T00:00:00Z
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