Postoperative Complications and Quality of Life in Patients with Esophageal Cancer after Esophagectomy using Gastric Tube: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LINRui-jiang ¹ , HUWen-teng ¹ , LUOWei ¹ , MAMin-jie ² , ZHANGYu ² , XUHuan ² ,  HANBiao ²

1. First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Department of Thoracic Surgery, First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding?author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Gastric tube; Whole stomach; Esophageal cancer; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140158

Video：

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Objective To systematically review the complications and quality of life (QoL) in patients with esophageal cancer after esophagectomy using gastric tube. Methods Randomized controlled trials (RCTs) about the postoperative complications and QoL of patients using gastric tube and the whole stomach reconstruction were electronically searched in PubMed, EMbase, The Cochrane Library, Web of Knowledge, CBM, CNKI, VIP and WanFang Data from inception to September 30th, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs involving 1 085 patients were included. The results of meta-analysis showed that, in terms of postoperative complications, the incidences of reflux esophagitis (OR=0.19, 95%CI 0.12 to 0.32, P < 0.000 01) and intrathoracic stomach syndrome (OR=0.11, 95%CI 0.04 to 0.32, P < 0.000 1) with gastric tube were significantly lower than those of the whole stomach; in terms of QoL, the scores of QoL in the 6th month (MD=18.71, 95%CI 7.72 to 29.71, P=0.000 9) and in the 12th month (MD=22.95, 95%CI 8.21 to 37.69, P=0.002) with gastric tube were significantly higher than those of the whole stomach. In terms of satisfaction degree of QoL, the satisfaction degree of QoL in the 6th month (OR=1.78, 95%CI 1.10 to 2.88, P=0.02) and the 12th month (OR=2.73, 95%CI 1.67 to 4.47, P < 0.000 1) with gastric tube were both significantly higher than those of the whole stomach. Conclusion Compared with the whole stomach reconstruction, the method of gastric tube reconstruction has beneficial effects in reducing the incidences of postoperative complications (such as reflux esophagitis, intrathoracic stomach syndrome) and improves patients' QoL. But there are many uncertain factors about postoperative anastomotic complication and its influence on patients' long-term QoL remains uncertain. Thus, further studies should be conducted.

Citation： LINRui-jiang, HUWen-teng, LUOWei, MAMin-jie, ZHANGYu, XUHuan, HANBiao. Postoperative Complications and Quality of Life in Patients with Esophageal Cancer after Esophagectomy using Gastric Tube: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 950-957. doi: 10.7507/1672-2531.20140158 Copy

1.	?Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med, 2003, 349(23): 2241-2252.
2.	Rice TW, Rusch VW, Apperson-Hansen C, et al. Worldwide esophageal cancer collaboration. Dis Esophagus, 2009, 22(1): 1-8.
3.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
4.	Kim SH, Lee KS, Shim YM, et al. Esophageal resection: indications, techniques, and radiologic assessment. Radiographics, 2001, 21(5): 1119-1137; discussion 1138-1140.
5.	Collard JM, Tinton N, Malaise J, et al. Esophageal replacement: gastric tube or whole stomach? Ann Thorac Surg, 1995, 60(2): 261-266; discussion 267.
6.	Pierie JP, de Graaf PW, van Vroonhoven TJ. The vascularization of a gastric tube as a substitute for the esophagus is affected by its diameter. Dis Esophagus, 1998, 11(4): 231-235.
7.	Boyle NH, Pearce A, Hunter D, et al. Intraoperative scanning laser Doppler flowmetry in the assessment of gastric tube perfusion during esophageal resection. J Am Coll Surg, 1999, 188(5): 498-502.
8.	Shu YS, Sun C, Shi WP, et al. Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage. Ir J Med Sci, 2013, 182(3): 477-480.
9.	Peng L, Han Y, Xie T, et al. Randomized controlled study of esophagectomy with gastric tube reconstruction versus whole stomach reconstruction for esophageal cancer patients. Chinese Journal of Clinical Oncology, 2009, 36(19): 1125-1127, 1131.
10.	Tabira Y, Sakaguchi T, Kuhara H, et al. The width of a gastric tube has no impact on outcome after esophagectomy. Am J Surg, 2004, 187(3): 417-421.
11.	Zhang C, Wu QC, Hou PY, et al. Impact of the method of reconstruction after oncologic oesophagectomy on quality of life-a prospective, randomised study. Eur J Cardio-Thorac, 2011, 39(1): 109-114.
12.	伍傳新, 陳樹群, 林昱, 等.管狀胃經食管床弓上吻合術對食管癌術后肺功能的影響.中華胃腸外科雜志, 2010, 13(6): 450-451.
13.	李小叢, 朱宏, 孫薇, 等.管狀胃代食管在老年食管癌手術中的應用.臨床外科雜志, 2013, 21(6): 447-449.
14.	梁海峰, 段林燦, 李高峰.管狀胃與全胃代食管在食管癌頸部吻合中的應用研究.中國社區醫師(醫學專業), 2011, 13(26): 54-55.
15.	王坤, 李偉, 吳喜燕, 等.管狀胃治療老年人食管癌臨床療效分析.中國老年醫學雜志, 2013, 32(2): 188-190.
16.	徐驍晗, 駱金華, 張石江, 等.管狀胃在食管癌根治術中的應用.南京醫科大學學報(自然科學版), 2010, 30(09): 1327-1329.
17.	茹玉航.管狀胃對食管癌切除術后患者生活質量的影響.實用癌癥雜志, 2013, 28(4): 376-378.
18.	王海東, 楊康, 廖克龍, 等.管狀胃食管吻合術對食管癌患者術后生活質量影響的臨床研究.重慶醫學, 2011, 40(12): 1162-1163, 1166.
19.	Barbera L, Kemen M, Wegener M, et al. Effect of site and width of stomach tube after esophageal resection on gastric emptying. Zentralbl Chir, 1994, 119(4): 240-244.
20.	Bonavina L, Anselmino M, Ruol A, et al. Functional evaluation of the intrathoracic stomach as an oesophageal substitute. Br J Surg, 1992, 79(6): 529-532.
21.	Mergue J, Veyrac M, Huin-Yan S, et al. pH monitoring for 24 hours of gastroesophageal reflux and gastric function after intrathoracic gastroplasty after esophagectomy. Surg Gynecol Obstet, 1990, 171(2): 107-110.
22.	陳文樹, 付向寧, 徐澄澄, 等.管狀胃對食管癌手術后胃食管反流的影響.華中科技大學學報(醫學版), 2011, 40(5): 593-596.
23.	D'Journo XB, Martin J, Ferraro P, et al. The esophageal remnant after gastric interposition. Dis Esophagus, 2008, 21(5): 377-388.
24.	Korenaga D, Toh Y, Maekawa S, et al. Intra-operative measurement of the tissue blood flow for evaluating blood supply to the gastric tube for esophageal reconstruction. Hepatogastroenterology, 1998, 45(24): 2179-2180.
25.	張雪飛, 史小男, 韓彪.機械與手工食管胃吻合術后吻合口瘺發生率比較的系統評價.中國循證醫學雜志, 2012, 12(11): 1367-1371.
26.	Lerut TE, van Lanschot JJ. Chronic symptoms after subtotal or partial oesophagectomy: diagnosis and treatment. Best Pract Res Clin Gastroenterol, 2004, 18(5): 901-915.
27.	Egberts JH, Schniewind B, Bestmann B, et al. Impact of the site of anastomosis after oncologic esophagectomy on quality of life--a prospective, longitudinal outcome study. Ann Surg Oncol, 2008, 15(2): 566-575.

1. ?Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med, 2003, 349(23): 2241-2252.
2. Rice TW, Rusch VW, Apperson-Hansen C, et al. Worldwide esophageal cancer collaboration. Dis Esophagus, 2009, 22(1): 1-8.
3. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2): 69-90.
4. Kim SH, Lee KS, Shim YM, et al. Esophageal resection: indications, techniques, and radiologic assessment. Radiographics, 2001, 21(5): 1119-1137; discussion 1138-1140.
5. Collard JM, Tinton N, Malaise J, et al. Esophageal replacement: gastric tube or whole stomach? Ann Thorac Surg, 1995, 60(2): 261-266; discussion 267.
6. Pierie JP, de Graaf PW, van Vroonhoven TJ. The vascularization of a gastric tube as a substitute for the esophagus is affected by its diameter. Dis Esophagus, 1998, 11(4): 231-235.
7. Boyle NH, Pearce A, Hunter D, et al. Intraoperative scanning laser Doppler flowmetry in the assessment of gastric tube perfusion during esophageal resection. J Am Coll Surg, 1999, 188(5): 498-502.
8. Shu YS, Sun C, Shi WP, et al. Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage. Ir J Med Sci, 2013, 182(3): 477-480.
9. Peng L, Han Y, Xie T, et al. Randomized controlled study of esophagectomy with gastric tube reconstruction versus whole stomach reconstruction for esophageal cancer patients. Chinese Journal of Clinical Oncology, 2009, 36(19): 1125-1127, 1131.
10. Tabira Y, Sakaguchi T, Kuhara H, et al. The width of a gastric tube has no impact on outcome after esophagectomy. Am J Surg, 2004, 187(3): 417-421.
11. Zhang C, Wu QC, Hou PY, et al. Impact of the method of reconstruction after oncologic oesophagectomy on quality of life-a prospective, randomised study. Eur J Cardio-Thorac, 2011, 39(1): 109-114.
12. 伍傳新, 陳樹群, 林昱, 等.管狀胃經食管床弓上吻合術對食管癌術后肺功能的影響.中華胃腸外科雜志, 2010, 13(6): 450-451.
13. 李小叢, 朱宏, 孫薇, 等.管狀胃代食管在老年食管癌手術中的應用.臨床外科雜志, 2013, 21(6): 447-449.
14. 梁海峰, 段林燦, 李高峰.管狀胃與全胃代食管在食管癌頸部吻合中的應用研究.中國社區醫師(醫學專業), 2011, 13(26): 54-55.
15. 王坤, 李偉, 吳喜燕, 等.管狀胃治療老年人食管癌臨床療效分析.中國老年醫學雜志, 2013, 32(2): 188-190.
16. 徐驍晗, 駱金華, 張石江, 等.管狀胃在食管癌根治術中的應用.南京醫科大學學報(自然科學版), 2010, 30(09): 1327-1329.
17. 茹玉航.管狀胃對食管癌切除術后患者生活質量的影響.實用癌癥雜志, 2013, 28(4): 376-378.
18. 王海東, 楊康, 廖克龍, 等.管狀胃食管吻合術對食管癌患者術后生活質量影響的臨床研究.重慶醫學, 2011, 40(12): 1162-1163, 1166.
19. Barbera L, Kemen M, Wegener M, et al. Effect of site and width of stomach tube after esophageal resection on gastric emptying. Zentralbl Chir, 1994, 119(4): 240-244.
20. Bonavina L, Anselmino M, Ruol A, et al. Functional evaluation of the intrathoracic stomach as an oesophageal substitute. Br J Surg, 1992, 79(6): 529-532.
21. Mergue J, Veyrac M, Huin-Yan S, et al. pH monitoring for 24 hours of gastroesophageal reflux and gastric function after intrathoracic gastroplasty after esophagectomy. Surg Gynecol Obstet, 1990, 171(2): 107-110.
22. 陳文樹, 付向寧, 徐澄澄, 等.管狀胃對食管癌手術后胃食管反流的影響.華中科技大學學報(醫學版), 2011, 40(5): 593-596.
23. D'Journo XB, Martin J, Ferraro P, et al. The esophageal remnant after gastric interposition. Dis Esophagus, 2008, 21(5): 377-388.
24. Korenaga D, Toh Y, Maekawa S, et al. Intra-operative measurement of the tissue blood flow for evaluating blood supply to the gastric tube for esophageal reconstruction. Hepatogastroenterology, 1998, 45(24): 2179-2180.
25. 張雪飛, 史小男, 韓彪.機械與手工食管胃吻合術后吻合口瘺發生率比較的系統評價.中國循證醫學雜志, 2012, 12(11): 1367-1371.
26. Lerut TE, van Lanschot JJ. Chronic symptoms after subtotal or partial oesophagectomy: diagnosis and treatment. Best Pract Res Clin Gastroenterol, 2004, 18(5): 901-915.
27. Egberts JH, Schniewind B, Bestmann B, et al. Impact of the site of anastomosis after oncologic esophagectomy on quality of life--a prospective, longitudinal outcome study. Ann Surg Oncol, 2008, 15(2): 566-575.

Chinese Journal of Evidence-Based Medicine

Postoperative Complications and Quality of Life in Patients with Esophageal Cancer after Esophagectomy using Gastric Tube: A Meta-Analysis

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