Risk Factors Ofesophagojejunal Anastomotic Leakage After Total Gastrectomy:A Meta-analysis

Objective:To systematically review the risk factors of esophagojejunal anastomotic leakage(EJAL)after total gastrectomy.Methods:Embase,PubMed,Web of Science,Cochrane Library,VIP,CBM,CNKI and Wanfangdatabase were searched from inceptionto October 2021 to collect clinical research about risk factors for EJAL after total gastrectomy.Then a meta-analysis was performed by Review Manager5.4 and Stata/SE15.1 software.Results:A total of 13 articles were enrolled.The results of meta-analyses showedthat age more than 65(OR=1.76,95%CI:1.24 to 2.51,P=0.002),BMI>25kg/m2(OR=1.81,95%CI:1.39 to 2.36,P<0.01),tumordiameter>4cm(OR=1.41,95%CI:1.06 to 1.89,P=0.02),pulmonary insufficiency(OR=1.95,95%CI:1.52 to 2.50,P<0.01),diabetes(OR=2.66,95%CI:1.59～4.47,P<0.01),preoperative serum albumin<35g/L(OR=2.19,95%CI:1.18 to 4.04,P=0.01),interoperative blood transfusion(OR=2.25,95%CI:1.26 to 4.00,P=0.006),and operation time>240min(OR=1.49,95%CI:1.01 to 2.19,P=0.04)significantly increased the risk for EJAL after total gastrectomy.However,there were not correlated with the risk of EJAL in gender,hypertension,lymph node metastasis,depth of invasion(T stage)(OR=1.12,0.98,0.81,0.82,95%CI:0.90 to 1.39,0.66 to 1.46,0.55 to 1.18,0.63 to 1.07,P>0.05).Conclusion:Age more than 65,BMI>25kg/m2,tumor size more than 4 centimeter,pulmonary insufficiency,diabetes,preoperative serum albumin levels less than 3 5g/L,interoperative blood transfusion and operation time>240minare risk factors of esophagojejunal anastomotic leakage after total gastrectomy.