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A comparison of the postoperative outcomes between intraoperative leak testing and no intraoperative leak testing for gastric cancer surgery: a systematic review and meta-analysis

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Abstract

Background

Postoperative anastomotic leakage (PAL) is a serious complication of gastric cancer surgery. Although perioperative management has made considerable progress, anastomotic leakage (AL) cannot always be avoided. The purpose of this study is to evaluate whether intraoperative leak testing (IOLT) can reduce the incidence of PAL and other postoperative outcomes in gastric cancer surgery.

Materials and methods

In this meta-analysis, we searched the PubMed, Embase, and Cochrane Library databases for clinical trials to assess the application of IOLT in gastric cancer surgery. All patients underwent laparoscopic radical gastrectomy for gastric cancer surgery. Studies comparing the postoperative outcomes of IOLT and no intraoperative leak testing (NIOLT) were included. Quality assessment, heterogeneity, risk of bias, and the level of evidence of the included studies were evaluated. PAL, anastomotic-related complications, 30-day mortality, and reoperation rates were compared between the IOLT and NIOLT group.

Results

Our literature search returned 721 results, from which six trials (a total of 1,666 patients) were included in our meta-analysis. Statistical heterogeneity was low. The primary outcome was PAL. IOLT reduced the incidence of PAL [2.09% vs 6.68%; (RR = 0.31, 95% Cl 0.19–0.53, P < 0.0001]. Anastomotic-related complications, which included bleeding, leakage, and stricture, were significantly higher in the NIOLT group than in the IOLT group [3.24% VS 10.85%; RR = 0.30, 95% Cl 0.18–0.53, P < 0.0001]. Moreover, IOLT was associated with lower reoperation rates [0.94% vs 6.83%; RR = 0.18, 95% CI 0.07–0.43, P = 0.0002].

Conclusion

Considering the observed lower incidence of postoperative anastomotic leakage (PAL), anastomotic-related complications, and reoperation rates, IOLT appears to be a promising option for gastric cancer surgery. It warrants further study before potential inclusion in future clinical guidelines.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We want to thank Dr. Michael Hillel Kleinman from Surgical Associates of Houston, Texas. Dr. Michael Hillel Klein-man helped Dr. Yunhong Tian dedicate work to the surgical practice and research in Gastrointestinal Surgery.

Funding

This work was supposed by the Foundation of Sichuan Medical Association [S21025], the Cooperative project of Nanchong City with North Sichuan Medical College [20SXQT0321], and the Bureau of Science & Technology Nanchong City [22JCYJPT0007].

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Authors and Affiliations

  1. Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China

    Heng Luo, Shunying Liu, Wentao Huang, Yu Lei, Binyu Luo, Wenjing Li & Yunhong Tian

  2. Department of Dermatology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China

    Shunying Liu

  3. Department of Gastroenterology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China

    Wentao Huang

  4. Department of Science &Technology with Teaching, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, China

    Yan Xing

  5. Department of Radiology, Wayne State University, Detroit, MI, 48201, USA

    Luke Wesemann & Jiani Hu

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Contributions

YT, LH, and SL have made substantial contributions to the design of the work. YL and BL interpreted the patients’ data. LH, SL, and TH were major contributors in writing the manuscript. YT, LH, and LW have drafted the work or substantively revised it. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yunhong Tian.

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Disclosures

Heng Luo, Shunying Liu, Wentao Huang, Yu Lei, Yan Xing, Luke Wesemann, Binyu Luo, Wenjing Li, Jiani Hu, and Yunhong Tian have no conflicts of interest to disclose.

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Luo, H., Liu, S., Huang, W. et al. A comparison of the postoperative outcomes between intraoperative leak testing and no intraoperative leak testing for gastric cancer surgery: a systematic review and meta-analysis. Surg Endosc 38, 1709–1722 (2024). https://doi.org/10.1007/s00464-024-10715-z

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