Evidence map›Paper›PMID 33461529›Full record

SynthesisBMC surgery2021

Interventions to prevent anastomotic leak after esophageal surgery: a systematic review and meta-analysis.

Emma J M Grigor, Suha Kaaki, Dean A Fergusson, Donna E Maziak, Andrew J E Seely

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 3 pooled it
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Review
  6. Article
  7. Article
  8. Review
  9. Article
  10. Improved anastomotic leakage rates after the "flap and wrap" reconstruction in Ivor Lewis esophagectomy for cancer.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2022
    Observational
  11. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Emma J M GrigorDepartment of Surgery, Division of Thoracic Surgery, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada. egrig010@uottawa.ca.ORCID http://orcid.org/0000-0003-4866-1142
Suha KaakiDepartment of Surgery, Division of Thoracic Surgery, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.
Dean A FergussonClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Donna E MaziakDepartment of Surgery, Division of Thoracic Surgery, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.
Andrew J E SeelyDepartment of Surgery, Division of Thoracic Surgery, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.
Ottawa Hospital · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review and critical appraisal of the efficacy and safety of all previous interventions aiming to reduce AL risk.

methodsWe searched MEDLINE and Embase from 1946 to January 2019 for randomized controlled trials (RCTs) evaluating interventions to minimize esophagogastric AL. Pooled risk ratios (RR) for AL were obtained using a random effects model.

resultsTwo reviewers screened 441 abstracts and identified 17 RCTs eligible for inclusion; 11 studies were meta-analyzed. Omentoplasty significantly reduced the risk of AL by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared to conventional anastomosis (3 studies, n = 611 patients). Early removal of NG tube significantly reduced the risk of AL by 62% [RR: 0.38; 95% CI: 0.02, 0.65] compared to prolonged NG tube removal (2 studies, n = 293 patients); Stapled anastomosis did not significantly reduce the risk of AL [RR: 0.92; 95% CI: 0.45, 1.87] compared to hand-sewn anastomosis (6 studies, n = 1454 patients). The quality of evidence was high for omentoplasty (vs. conventional anastomosis), moderate for early NG tube removal (vs. prolonged NG tube removal), and very low for stapled anastomosis (vs. hand-sewn anastomosis).

conclusionsThis is the first meta-analysis to summarize the graded quality of evidence for all RCT interventions designed to reduce the risk of AL following esophagectomy. Our findings demonstrated that omentoplasty significantly reduced the risk of AL with a high quality of evidence. Although early NG tube removal significantly reduced AL risk, there is a need for further research to strengthen the quality of evidence for this finding. Evidence profiles presented in our review may help inform the development of future clinical practice recommendations. Systematic review registration: CRD42019127181.

Indexed as

Anastomosis, SurgicalAnastomotic LeakEsophageal NeoplasmsEsophagectomyHumansRandomized Controlled Trials as TopicAdverse eventsAnastomotic leakageCancerCarcinomaEsophagectomyIntervention

Identifiers

PMID33461529
PMCPMC7814645
OpenAlexW3112161679

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.