P74 A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF ANASTOMOTIC TECHNIQUES FOR OESOPHAGECTOMY FOR MALIGNANCY

Abstract Aims This systematic review and network meta-analysis evaluates the evidence for the techniques for oesophagogastric (OG) anastomosis and their impact on perioperative outcomes. Background Current evidence on the benefits of different anastomotic techniques (hand-sewn (HS), circular stapled (CS), triangular stapler (TS) or linear stapler/semi-mechanical (LSSM) techniques after oesophagectomy is conflicting. Methods A systematic literature search was conducted to identify randomised and non-randomised studies reporting techniques for the OG anastomosis. Network meta-analysis of postoperative anastomotic leaks and strictures was performed. Results This study included 15 randomised and 22 non-randomised studies (n=8,618). LSSM (OR: 0.49, CI95%: 0.33 - 0.74, p=0.001) and CS (OR: 0.68, CI95%: 0.48 - 0.95, p=0.027) and anastomoses were associated with lower anastomotic leak rates than HS anastomosis. LSSM anastomosis was found to be superior to CS (OR: 0.15, CI95%: 0.08 - 0.28, p <0.001), TS (OR: 0.32, CI95%: 0.19 - 0.54, p <0.001) and HS (OR: 0.15, CI95%: 0.05 - 0.46, p=0.001) anastomoses respectively in anastomotic stricture rates. LSSM was ranked the best technique with high probability for anastomotic leaks and strictures. Conclusions Stapled anastomoses, specifically LSSM were associated with lower anastomotic leaks and strictures rates following oesophagectomy. Therefore, current evidence suggests superiority of the LSSM technique for OG anastomosis.