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

Introduction: 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. Methods: Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: 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. Conclusions: 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，相关外科手术的开展频次日益增加。吻合口漏（anastomotic leakage, AL）是胃食管外科手术最令人担忧的术后并发症之一。针对该并发症可采用保守治疗、内镜治疗（如内镜负压治疗、支架置入术）或外科手术干预，但目前最优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）胃食管恶性肿瘤术后吻合口漏的不同内镜治疗方案。方法：本研究为系统评价与荟萃分析，通过检索三个在线数据库，纳入评估胃食管癌术后吻合口漏外科与内镜治疗方案的相关研究。结果：本研究共纳入32项研究，涉及1080例患者。与外科干预相比，内镜治疗在临床成功率、住院时长及重症监护病房（intensive care unit, ICU）停留时长上无显著差异，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住院时长更短（均数差mean difference, MD=−14.77天，95%CI：−26.57~−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上无显著差异。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。不过仍需开展更多高质量的对比研究，尤其是明确针对特定患者及吻合口漏特征的最优治疗方案。