Systematic Review Session
AB051. SOH24AB_175. Oesophageal reconstruction options: a systematic review and network meta-analysis
Muireann Keating1, Matthew Davey2, William Murray3, Hugo Temperley1, Brendan Moran4, Narayanasamy Ravi4, Claire Donohoe4, John Reynolds4, Noel Donlon4
1Department of Plastic and Reconstructive Surgery, St James’s Hospital, Dublin, Ireland;
2Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland;
3Department of General Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland;
4Department of Upper GI Surgery, St James’s Hospital, Dublin, Ireland
Background: Oesophageal reconstruction is a complex operation that continues to present a surgical challenge associated with significant morbidity and its associated sequela. The conventional gastric pull remains the gold standard reconstructive technique when available. Alternative conduits for oesophageal replacement become necessary when the stomach is unavailable with common options for conduit creation being the jejunum and the colon. The aim of this systematic review and network meta-analysis (NMA) was to interrogate outcomes in oesophageal reconstruction with gastric pull-up, colonic interposition and jejunal flap.
Methods: A systematic review of three electronic databases (PubMed, EMBASE, SCOPUS) was undertaken. A NMA as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was carried out using R and Shiny.
Results: A total of 19 studies, including 3,927 patients was included. Among them, 79.5% (3,123/3,927) of patients included underwent gastric pull-up, 13.5% (531/3,927) of patients under went colonic interposition and 7% (273/3,927) of patients underwent jejunal flap as their reconstructive method. At NMA there was no significant difference in mortality rates, stricture formation, graft necrosis and length of stay between the three reconstructive techniques. Trend results showed jejunal flap performed better than colonic interposition in length of stay, mortality rates and stricture formation.
Conclusions: At present, the gastric conduit is the first choice for oesophageal reconstruction after oesophagectomy. Colonic interposition and jejunal free flap represent viable options and are associated with non-inferior short term surgical outcomes when gastric pull up is not available.
Keywords: Meta-analysis; oesophagectomy; oesophageal cancer; reconstruction; systematic review
Acknowledgments
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-24-ab051
Cite this abstract as: Keating M, Davey M, Murray W, Temperley H, Moran B, Ravi N, Donohoe C, Reynolds J, Donlon N. AB051. SOH24AB_175. Oesophageal reconstruction options: a systematic review and network meta-analysis. Mesentery Peritoneum 2024;8:AB051.
