PROSPERO

International prospective register of systematic reviews

Management of intrathoracic and cervical anastomotic leakage after esophagectomy for

esophageal cancer: a systematic review
Vanessa Oliveira, Moniek Verstegen, Stefan Bouwense, Peter Siersema, Maroeska Rovers, Frans van
Workum, Camiel Rosman

Citation
Vanessa Oliveira, Moniek Verstegen, Stefan Bouwense, Peter Siersema, Maroeska Rovers, Frans
van Workum, Camiel Rosman. Management of intrathoracic and cervical anastomotic leakage
after esophagectomy for esophageal cancer: a systematic review. PROSPERO 2016
CRD42016032374 Available from:
http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016032374

Review question
What is the best treatment possible of anastomotic leakage after esophagectomy (in patients with cancer of
the esophagus/cardia)?
Differ the best possible treatment in leaks of intrathoracic anastomoses from leaks of cervical anastomoses?

Searches
A systematic literature search was conducted in the electronic databases MEDLINE, EMBASE and Web of
Science from inception through April 2017.
No restrictions regarding language, year of publication, or publication status were imposed.
We identified additional studies by scanning the reference list of articles.

Types of study to be included

Observational cohort studies, randomized controlled trials, unpublished cohorts/trials.

Condition or domain being studied

Anastomotic leakage after esophagectomy.

Participants/population
Inclusion: adults with an anastomotic leak after esophagectomy. Indication for operation: cancer of
esophagus or gastric cardia. Esophagogastric reconstruction was performed by using remnant stomach.
Exclusion: adolescents (under 18 years of age).

Intervention(s), exposure(s)
Esophagectomy.

Comparator(s)/control
Not applicable.

Primary outcome(s)
Mortality rate.

Secondary outcome(s)
Success rate, severe complications (Clavien-Dindo 3 or higher), length of hospital stay, length of stay on the
ICU, reintervention (surgical, endoscopic and radiological), new onset of organ failure and quality of life.

Data extraction (selection and coding)

Two authors (MV and SB) will fill out a standardized scoring sheet containing all relevant parameters.
Discrepancies will be resolved by discussion with a third author (CR). The scoring sheet contains the
following predefined variables:

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International prospective register of systematic reviews

1. Study and patient characteristics: first author, year of publication, country of origin, number of included
patients, study design, type of modality used to diagnose the leakage, type of operation, location of
anastomosis.
2. Data regarding leak characterization: time from esophagectomy to diagnosis of the leakage, time from
diagnosis treatment of the leakage, mean interval of leakage treatment, circumference of the leakage, length
of the leakage, gastric tube overall condition, extent of contamination.
2. Outcome parameters: mortality rate, success rate, severe complications, reintervention rate reoperation
rate, new onset of organ failure, hospital length of stay, ICU length of stay, quality of life.

Risk of bias (quality) assessment

Methodological quality of the included studies will be assessed according to the revised version of the
Newcastle-Ottawa Scale (file:///D:/Documenten/Downloads/appb-fm4.pdf). Maximum score is five stars. Five
stars is considered high quality, three to four stars is considered intermediate quality and one-two stars, low
quality. Two authors will assess the qualitity of the studies (MV and SB). Disagreements will be resolved by
discussion with a third author (CR).

Strategy for data synthesis

A quantitative analysis of mortality per subgroup will be conducted.
Probably a descriptive analysis of most of the secondary outcomes will also be carried out.

Analysis of subgroups or subsets

Subgroups: intrathoracal vs. cervical. Subgroups per treatment of leakage: 1. conservative, 2. endoscopic
drainage, 3. endoscopic stent, 4. endoscopic VAC therapy, and 5. reoperation.

Contact details for further information

Moniek Verstegen
moniek.verstegen@radboudumc.nl

Organisational affiliation of the review

Radboudumc
https://www.radboudumc.nl/Pages/default.aspx

Review team members and their organisational affiliations

Miss Vanessa Oliveira. Universidade Federal de São Paulo
Mrs Moniek Verstegen. Radboudumc
Dr Stefan Bouwense. Radboudumc
Professor Peter Siersema. Radboudumc
Professor Maroeska Rovers. Radboudumc
Mr Frans van Workum. Radboudumc
Professor Camiel Rosman. Radboudumc

Anticipated or actual start date

01 September 2015

Anticipated completion date

15 November 2017

Funding sources/sponsors
None.

Conflicts of interest
None known

Language
English

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International prospective register of systematic reviews

Country
Netherlands

Stage of review
Review_Completed_not_published

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Anastomosis, Surgical; Anastomotic Leak; Esophageal Neoplasms; Esophagectomy; Humans; Neck;
Postoperative Care; Postoperative Complications; Postoperative Period; Thorax

Date of registration in PROSPERO

24 August 2016

Date of publication of this version

05 January 2018

Details of any existing review of the same topic by the same authors
Stage of review at time of this submission

Stage Started Completed

Preliminary searches Yes Yes

Piloting of the study selection process Yes Yes

Formal screening of search results against eligibility criteria Yes Yes

Data extraction Yes Yes

Risk of bias (quality) assessment Yes Yes

Data analysis Yes Yes

Versions
24 August 2016
05 January 2018

PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration
record, any associated files or external websites.

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