Linear- Versus Circular-Stapled Esophagojejunostomy During Total Gastrectomy: Systematic Review and Meta-Analysis

While numerous techniques have been defined for esophagojejunostomy (EJ) during total gastrectomy including hand-sewn and stapled anastomoses, mechanical linear-stapled (LS) and circular-stapled (CS) anastomoses are widely adopted. However, there are scarce data on the optimal stapled technique for EJ during total gastrectomy. Scopus, Web of Science, MEDLINE, and PubMed were investigated up to October 30, 2022. We considered articles that appraised short-term outcomes after LS versus CS anastomosis in patients undergoing total gastrectomy for gastric cancer. Anastomotic leak (AL), anastomotic stricture (AS), and anastomotic bleeding (AB) were primary outcomes. Risk ratio (RR) and standardized mean difference (SMD) were used as pooled effect size measures, whereas 95% confidence intervals (95% CIs) were used to calculate related inference. Sixteen studies (3156 patients) were incorporated. Overall, 1540 (48.8%) underwent CS, whereas 1616 (51.2%) underwent LS. Compared with CS, LS was related to a condensed RR for AS (RR: 0.27; 95% CI 0.15-0.49;  < .01), whereas no differences were found for AL (RR: 0.75; 95% CI 0.51-1.10;  = .14) and AB (RR: 0.59; 95% CI 0.24-1.44;  = .25). Postoperative pneumonia (RR: 0.98;  = .94), operative time (SMD: 0.51;  = .31), days to soft diet (SMD: -0.08;  = .36), hospital stay (SMD: 0.19;  = .46), and 30-day mortality (RR: 1.76;  = .31) were comparable between LS and CS. For EJ during total gastrectomy, our results suggest that LS seems related to a reduced risk of AS compared with CS, although no significant differences were found for the risk of AL and AB between the two techniques. Clinical Trial Registration number: CRD42022381221.