Meta-Analysis Of The Risk Factors For Anastomotic Leakage After Resection Of Esophageal Carcinoma

Objective: To evaluate the risk factors of esophageal anastomotic leakage(EAL), to further explore the factors related to the anastomosis,to prevent and reduce the incidence of anastomotic leakage have the vital significance.Methods: We included all studies which analyzed the risk factors of esophageal carcinoma(cancer)anastomotic leakage(fistula).Through the following electronic database MEDLINE(1993 ~ 2014.07) 、 EMBASE(1993 ~ 2014.07) 、 Chinese Biomedical Literature Database(CBM1993~2014.07)、China National Knowledge Infrastructure(CNKI1993 ~ 2014.07) 、 Chinese Scientific Journal Database(1994 ~2014.07)、Chinese Biomedical Journal Database(CMCC1993~2014.07)、Wanfang database(1993~2014.07),etc. The Revman 5.0 and the Peto method were used for Meta-analyses.Results: According to the inclusion and exclusion criteria, included in the Metaanalysis with 24 references.The incidence rate was lower in the female patients than in the male ones, the combined OR and 95%confidence interval was 0.73(0.54~1.00), but there was no statistical significance between them(P=0.05). The incidence rate was higher in the patients over the age of 60 years old than in those younger,the combined OR and 95%confidence interval was 0.79(0.56~1.10), but there was no statistical significance between them(P>0.05). The incidence rate was higher in the patients who had diabetes mellitus than in those who had not, the combined OR and 95%confidence interval was 2.40(1.64~3.52)(P<0.01). The incidence rate was lower in the patients with serum albumin was 35g/L and above than lack of 35g/L, the combined OR and 95%confidence interval was 15.06(9.82~23.10)(P<0.01). The incidence rate was higher in the patients who had respiratory system disease than in those who had not, the combined OR and 95%confidence interval was 10.04(6.92~14.58)(P<0.01). The incidence rate was higher in the patients who had hypertension than in those who had not, the combined OR and 95%confidence interval was 2.40(1.64~3.52)(P<0.01). The incidence rate was higher in the patients who had treatment by radiotherapy than in those who had not, the combined OR and 95%confidence interval was7.21(3.20~16.20)(P<0.01). The incidence rate was lower in the patients withⅠandⅡstages than in those with Ⅲand Ⅳstages, the combined OR and 95%confidence interval was0.18(0.12~0.27)(P<0.01). The incidence rate was lower in the patients who operation time less than 4.5 hours than in those who more than 4.5 hours, the combined OR and 95%confidence interval was0.25(0.16~0.37)(P<0.01). The incidence rate was higher in the patients who had treatment by manual anastomosis than in those who had received stapler anastomosis, the combined OR and 95%confidence interval was0.61(0.43~0.86)(P<0.01). The incidence rate was higher in the patients who had retrosternal reconstruction approach than in those who had esophageal bed reconstruction approach, the combined OR and 95%confidence interval was3.20(2.41~4.25)(P<0.01).Conclusion: The risk factors of anastomotic fistula after resection of esophageal carcinoma are as follows: diabetes mellitus, preoperative serum albumin lower than 35g/L, respiratory system disease, hypertension, preoperative neoadjuvant radiotherapy, The Ⅲ and stage of esophageal cancer, operation time more than 4.5 Ⅳhours, manual anastomosis, substernal cervical anastomosis.