Short-term Outcomes of Different Techniques for Gastric Ischemic Pre-Conditioning Before Esophagectomy: A Network Meta-Analysis.

Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
13 Oct 2023
Historique:
medline: 13 10 2023
pubmed: 13 10 2023
entrez: 13 10 2023
Statut: aheadofprint

Résumé

Ischemia at the anastomotic site is a critical protagonist in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the vascular perfusion at the tip of the gastric conduit with a potential effect on anastomotic leak (AL) and stenosis (AS) risk minimization. Laparoscopic (LapGIC) and angioembolization (AngioGIC) techniques have been reported. Compare short-term outcomes among different GIC techniques. Systematic review and network meta-analysis. One-step esophagectomy (noGIC), LapGIC, and AngioGIC were compared. Primary outcomes were AL, AS, and gastric conduit necrosis (GCN). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. Overall, 1760 patients (14 studies) were included. Of those, 1028 patients (58.4%) underwent noGIC, 593 (33.6%) LapGIC, and 139 (8%) AngioGIC. AL was reduced for LapGIC vs. noGIC (RR=0.68; 95% CrI 0.47-0.98) and AngioGIC vs. noGIC (RR=0.52; 95% CrI 0.31-0.93). Similarly, AS was reduced for LapGIC vs. noGIC (RR=0.32; 95% CrI 0.12-0.68) and AngioGIC vs. noGIC (RR=1.30; 95% CrI 0.65-2.46). The indirect comparison, assessed with the network methodology, did not show any differences for LapGIC vs. AngioGIC in term of postoperative AL and AS risk. No differences were found for GCN, pulmonary complications, overall complications, hospital length of stay, and 30-day mortality among different treatments. Compared to noGIC, both LapGIC and AngioGIC before esophagectomy seem equivalent and associated with a reduced risk for postoperative AL and AS.

Sections du résumé

BACKGROUND BACKGROUND
Ischemia at the anastomotic site is a critical protagonist in the development of anastomosis-related complications after esophagectomy. Gastric ischemic conditioning (GIC) before esophagectomy has been described to improve the vascular perfusion at the tip of the gastric conduit with a potential effect on anastomotic leak (AL) and stenosis (AS) risk minimization. Laparoscopic (LapGIC) and angioembolization (AngioGIC) techniques have been reported.
PURPOSE OBJECTIVE
Compare short-term outcomes among different GIC techniques.
METHODS METHODS
Systematic review and network meta-analysis. One-step esophagectomy (noGIC), LapGIC, and AngioGIC were compared. Primary outcomes were AL, AS, and gastric conduit necrosis (GCN). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference.
RESULTS RESULTS
Overall, 1760 patients (14 studies) were included. Of those, 1028 patients (58.4%) underwent noGIC, 593 (33.6%) LapGIC, and 139 (8%) AngioGIC. AL was reduced for LapGIC vs. noGIC (RR=0.68; 95% CrI 0.47-0.98) and AngioGIC vs. noGIC (RR=0.52; 95% CrI 0.31-0.93). Similarly, AS was reduced for LapGIC vs. noGIC (RR=0.32; 95% CrI 0.12-0.68) and AngioGIC vs. noGIC (RR=1.30; 95% CrI 0.65-2.46). The indirect comparison, assessed with the network methodology, did not show any differences for LapGIC vs. AngioGIC in term of postoperative AL and AS risk. No differences were found for GCN, pulmonary complications, overall complications, hospital length of stay, and 30-day mortality among different treatments.
CONCLUSIONS CONCLUSIONS
Compared to noGIC, both LapGIC and AngioGIC before esophagectomy seem equivalent and associated with a reduced risk for postoperative AL and AS.

Identifiants

DOI: 10.1097/SLA.0000000000006124 PMID: 37830253
pubmed: 37830253
doi: 10.1097/SLA.0000000000006124
pii: 00000658-990000000-00674
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

Auteurs

Alberto Aiolfi (A)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Davide Bona (D)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Gianluca Bonitta (G)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Luigi Bonavina (L)

University of Milan, Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Milan, Italy.

Luigi Cayre (L)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Guglielmo Guerrazzi (G)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Christian A Gutschow (CA)

Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.

John Lipham (J)

Division of General Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street HCC 4, Suite 6200, Los Angeles, CA 90033, USA; Division of Minimally Invasive Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street HCC 4, Suite 6200, Los Angeles, CA 90033, USA.

Michele Manara (M)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Călin Popa (C)

Department of Surgery, Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca-Napoca, 400023, Romania.

Emanuele Rausa (E)

Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.

Diana Schlanger (D)

Department of Surgery, Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca-Napoca, 400023, Romania.

Sebastian Schoppmann (S)

Department of Surgery, Medical University of Vienna, Vienna, Austria.

Aleksandar Simić (A)

Department of Esophagogastric Surgery, University Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.

Andrea Sozzi (A)

I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Italy.

Joerg Zehetner (J)

Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Berne, Switzerland.

Classifications MeSH