Supplementary Material for: Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management

<b><i>Introduction:</i></b> With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery. <b><i>Methods:</i></b> Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. <b><i>Results:</i></b> A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95% CI: 23.9–48.5%]. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI: 0.127–0.954]), shorter ICU length of stay (mean difference −14.77 days [95% CI: −26.57 to −2.98]), and time until AL resolution (17.6 days [95% CI: 14.1–21.2] vs. 39.4 days [95% CI: 27.0–51.8]) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay. <b><i>Conclusions:</i></b> Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).

**引言：** 随着食管与胃癌发病率的上升，胃食管相关外科手术的实施愈发频繁。吻合口漏（anastomotic leakage, AL）是胃食管外科手术最凶险的术后并发症之一。其治疗可采用保守治疗、内镜治疗（如内镜负压治疗与支架置入术）或外科手术，但最佳治疗方案仍存在争议。本荟萃分析旨在对比（a）内镜与外科干预手段，以及（b）胃食管癌术后吻合口漏的各类内镜治疗方案。
**方法：** 本研究为系统评价与荟萃分析，通过三个在线数据库检索评估胃食管癌术后吻合口漏外科与内镜治疗效果的相关研究。
**结果：** 本研究共纳入32项研究，涉及1080例患者。与外科干预手段相比，内镜治疗的临床成功率、住院时长及重症监护病房（Intensive Care Unit, ICU）时长均无显著差异，但院内死亡率更低（6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95% CI: 23.9–48.5%]）。与支架置入术相比，内镜负压治疗的并发症发生率更低（比值比（Odds Ratio, OR）0.348 [95% CI: 0.127–0.954]），ICU时长更短（均数差（Mean Difference, MD）-14.77天 [95% CI: -26.57至-2.98]），吻合口漏愈合时间更短（17.6天 [95% CI:14.1–21.2] vs. 39.4天 [95% CI:27.0–51.8]），但二者在临床成功率、死亡率、再次干预率及住院时长方面无显著差异。
**结论：** 与外科手术相比，内镜治疗（尤其是内镜负压治疗）似乎更为安全有效。但仍需开展更具说服力的对比研究，以明确针对特定患者情况及漏口特征的最佳治疗方案。