Anastomotic leaks following esophagectomy occurred in 11% of patients and were associated with increased in-hospital mortality (OR 5.91; 95% CI 1.41-24.79; P=0.015).
Meta-Analysis (n=74,226)
Yes
What are the risk factors for anastomotic leaks following esophagectomy and what are the associated clinical outcomes?
Anastomotic leaks following esophagectomy are a major complication associated with significantly increased risks of pulmonary and cardiac complications, prolonged hospital stay, and in-hospital mortality.
Effect estimate: OR 5.91 (95% CI 1.41-24.79)
p-value: p=0.015
Anastomotic leaks (AL) are a major complication after esophagectomy. This meta-analysis aimed to determine identify risks factors for AL (preoperative, intra-operative, and post-operative factors) and assess the consequences to outcome on patients who developed an AL. This systematic review was performed according to PRISMA guidelines, and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling and prospectively registered with the PROSPERO database (Registration CRD42018130732). This review identified 174 studies reporting outcomes of 74,226 patients undergoing esophagectomy. The overall pooled AL rates were 11%, ranging from 0 to 49% in individual studies. Majority of studies were from Asia (n = 79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative). AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99-6.89, P < 0.001) and cardiac complications (OR: 2.44, CI95%: 1.77-3.37, P < 0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10-21 days, P < 0.001), and in-hospital mortality (OR: 5.91, CI95%: 1.41-24.79, P = 0.015). AL are a major complication following esophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL, which can be a target for interventions to reduce AL rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counseling, and informed consent.
Kamarajah et al. (Mon,) conducted a meta-analysis in Esophagectomy (n=74,226). Anastomotic leak vs. No anastomotic leak was evaluated on In-hospital mortality (OR 5.91, 95% CI 1.41-24.79, p=0.015). Anastomotic leaks following esophagectomy occurred in 11% of patients and were associated with increased in-hospital mortality (OR 5.91; 95% CI 1.41-24.79; P=0.015).
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