Pyloric Drainage During Esophagectomy: A Meta-Analysis Review

Surgical procedures, particularly minimally invasive esophagectomy (MIE), can be curative in early-stage esophageal cancer. In the past, intraoperative pyloroplasty was routinely performed, but its necessity has become debated with the rise of MIE.

Armand Csontos and the team aimed to examine the outcomes of gastric conduit esophageal reconstructions with or without pyloroplasty.

A comprehensive search of multiple databases identified randomized controlled trials on the topic, 2 independent authors selected studies based on predefined criteria. Statistical analysis assessed significant differences, and data bias and quality were then evaluated.

The results showed that nine relevant RCTs involving 529 patients with esophageal cancer were identified. No significant differences were found in mortality [odds ratio (OR): 0.85; P= 0.642], anastomosis leakage (OR: 0.57; P= 0.254), respiratory morbidity (OR: 0.51; P= 0.214), or vomiting (OR: 0.74; P= 0.520).

However, results regarding gastric emptying time (GET) were controversial [weighted mean difference (WMD): -67.71; P= 0.009; OR: 2.75; P= 0.072]. Significant heterogeneity was not detected except for GET. Trial sequential analyses (TSA) indicated that more data are needed for a definitive conclusion, except for the binary variables of GET.

The study concluded that pyloric drainage is not routinely necessary, but further well-designed studies are needed, particularly in Europe.

No financial support was provided.

Source: https://pubmed.ncbi.nlm.nih.gov/39165646/

Csontos A, Németh D, Szakó L, et al. (2024). “Intraoperative pyloric drainage is unnecessary during esophagectomies: a meta-analysis and systematic review of randomized controlled trials.” Pathol Oncol Res. 2024;30:1611823. Published 2024 Aug 6. doi:10.3389/pore.2024.1611823