Comparative Safety And Efficacy Of Anterior And Posterior Gastric Conduit Reconstruction After Esophagectomy: A Systematic Review

Objective:Reconstruction of the gastric conduit in cancer patients followingesophagectomy is most often performed through either an anterior or posteriormediastinal procedure. To determine whether one route is preferable to the other,we compared their safety and efficacy in a meta-analysis of randomizedcontrolled trials(RCTs).Methods: The RCTs were identified by searching Medline, Embase, theCochrane CENTRAL databases,CBM,CNKI,VIP and web site of clinic trialscenters without language restrictions.Results:Six studies involving292participants were included in themeta-analysis, which failed to show any significant differences between theanterior or posterior mediastinal route in terms of primary or secondary outcomes. Primary outcomes were operatively mortality [relative risk (RR)2.38,95%confidence interval (CI)0.95to5.93, P=0.17], anastomotic leakage (RR0.82,95%CI0.47to1.42, P=0.48), postoperative cardiac complications (RR1.76,95%CI0.9to3.46, P=0.1), and pulmonary morbidity (RR1.56,95%CI0.96to2.52, P=0.07). Secondary outcomes included dysphagia (RR0.92,95%CI0.48to1.74, P=0.79), anastomotic stricture (RR0.87,95%CI0.51to1.50, P=0.62], regular oral food intake (RR1.02,95%CI0.87to1.2, P=0.78),weight loss (RR1.53,95%CI0.73to3.23, P=0.26), weight gain (RR0.43,95%CI0.17to1.09, P=0.08), and constant weight (RR0.85,95%CI0.59to1.21,P=0.36).Conclusion:Our meta-analysis suggests similar safety and efficacy for bothanterior and posterior mediastinal procedures for reconstructing the gastricconduit after esophagectomy. These conclusions should be confirmed inlarge-scale randomized controlled trials.