目的:胃导管和气道之间的新食管气道瘘(NEAF)是一种罕见但危及生命的食管癌切除术并发症。最佳治疗仍然未知。对高质量病例系列的荟萃分析可能有助于确定是否仅非手术管理(NOM),前期手术(S),或NOM后手术(NOM+S)与更好的治疗后一年死亡率相关,恢复口服饮食和瘘管复发。
方法:我们系统地搜索了PubMed,EMBASE,和WebofScience的英文出版物报道NEAF患者的管理和生存病例系列。在177项确定的研究中,62个是重复的,95个与我们的主题无关。在全文回顾后,三项研究被排除在外,由于没有报告1年生存率。确定的出版物的排除标准是:仅摘要,恶性NEAF,没有食管切除术和胃吻合术,少于五名患者,而NEAF不是研究的主要重点。根据MOOSE指南进行数据提取。使用随机效应模型汇集数据。
结果:纳入了17项研究(302例患者)。NOM+S(33%;95CI,0.17-0.48)治疗后一年死亡率明显低于NOM(68%;95CI,0.39-0.97)或S(67%;95CI,0.36-0.98)。瘘位置与1年死亡率无关。在不同的治疗策略中,恢复口服饮食和瘘管复发都没有显着差异。
结论:NOM为患者准备手术,然后进行手术修复可能为NEAF患者提供最高的1年生存率。然而,三种治疗策略的患者选择标准可能影响我们的研究结果.
OBJECTIVE: Neo-oesophageal-airway fistula (NEAF) between gastric conduit and airway is a rare but life-threatening complication of oesophagectomy for oesophageal cancer. Optimal treatment remains unknown. A meta-analysis of good-quality case series may help determine whether nonoperative management (NOM) only, upfront surgery (S), or NOM followed by surgery is associated with better 1-year post-treatment mortality, resumption of oral diet and fistula recurrence.
METHODS: We systematically searched PubMed, EMBASE and Web of Science for publications in English reporting case series of management and survival in patients with NEAF. Of the 177 identified studies, 62 were duplicates and 95 were not relevant to our topic. Three studies were excluded after a full-text review, due to absence of reporting of 1-year survival. Exclusion criteria to identified publications were: abstract only, malignant NEAF, absence of oesophagectomy and esogastric anastomosis, fewer than 5 patients and NEAF not the main focus of the study. Data-extraction was conducted in accordance with MOOSE guidelines. Data were pooled using random-effects model.
RESULTS: Seventeen studies (302 patients) were included. One-year post-treatment mortality was considerably lower with NOM followed by surgery [33%; 95% confidence interval (CI), 0.17-0.48] than with NOM (68%; 95% CI, 0.39-0.97) or S (67%; 95% CI, 0.36-0.98). Fistula location was not associated with 1-year mortality. Neither resumption of an oral diet nor fistula recurrence differed significantly across treatment strategies.
CONCLUSIONS: NOM to prepare patients for surgery followed by surgical repair may provide the highest 1-year survival of patients with NEAF. However, patient selection criteria to each of 3 treatment strategies may have affected our findings.