Document Detail

Omentoplasty for esophagogastrostomy after esophagectomy.
MedLine Citation:
PMID:  23152259     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Esophagectomy followed by esophagogastrostomy is the preferred treatment for early-stage esophageal cancer. It carries the risk of anastomotic leakage after esophagogastric anastomosis, which is one of the most dangerous complications and causes considerable morbidity and mortality. Omentoplasty was recommended in some studies to preventing anastomotic leaks associated with esophagogastrostomy. However, the value of omentoplasty for esophagogastrostomy after esophagectomy has not been systematically reviewed.
OBJECTIVES: To assess the effects of omentoplasty for esophagogastrostomy after esophagectomy in esophageal cancer patients.
SEARCH METHODS: A comprehensive search strategy was carried out to identify eligible studies for inclusion in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PubMed and other reliable resources.
SELECTION CRITERIA: Randomized controlled trials comparing omentoplasty with no omentoplasty for esophagogastrostomy after esophagectomy in esophageal cancer patients were eligible for inclusion.
DATA COLLECTION AND ANALYSIS: Two review authors (Yong Yuan and Xiaoxi Zeng) independently assessed the quality of included studies and extracted data, with disagreements resolved by arbitration by another review author. Results of dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI), while continuous outcomes were expressed as mean differences (MD) with 95% CI. Meta-analysis was performed where the data available were sufficiently similar. Subgroup analysis was carried out based on different operation approaches.
MAIN RESULTS: Two randomized controlled trials (449 participants) were included in the review. There was no significant difference for hospital mortality between the study (with omentoplasty) and the control group (without omentoplasty) (RR 1.00; 95% CI 0.25 to 3.92). Neither of the included studies reported the difference of long-term survival between two groups. The incidence of postoperative anastomotic leakage was significantly lower in patients treated with omentoplasty than those without (RR 0.22; 95% CI 0.08 to 0.58); but the additional benefit only showed in patients receiving a transhiatal esophagogastrectomy (THE) procedure in subgroup analysis (THE: RR 0.23; 95% CI 0.07 to 0.79; transthoracic esophagogastrectomy (TTE): RR 0.19; 95% CI 0.03 to 1.03). Omentoplasty did not significantly improve other surgical-related complications, anastomotic strictures (RR 0.73; 95% CI 0.21 to 2.58) and duration of hospitalization (MD -2.70; 95% CI -6.01 to 0.61).
AUTHORS' CONCLUSIONS: Omentoplasty may provide an additional benefit to decrease the incidence of anastomotic leakage after esophagectomy and esophagogastrostomy for esophageal cancer patients without increasing or decreasing other complications, especially for those patients treated with THE. Further randomized controlled trials are still needed to investigate the influences of omentoplasty in different operation procedures of esophagectomy and esophagogastrostomy on the incidence of anastomotic leakage, anastomotic stricture, long-term survival rate and quality of life after esophagectomy and esophagogastrostomy.
Yong Yuan; Xiaoxi Zeng; Yang Hu; Tianpeng Xie; Yongfan Zhao
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2012-11-14
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  11     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-15     Completed Date:  2013-01-15     Revised Date:  2014-11-05    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD008446     Citation Subset:  IM    
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MeSH Terms
Anastomotic Leak / etiology
Esophageal Neoplasms / surgery*
Esophagostomy / methods*
Gastrostomy / methods*
Omentum / surgery*
Randomized Controlled Trials as Topic
Update In:
Cochrane Database Syst Rev. 2014;10:CD008446   [PMID:  25274134 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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