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Abstract Objectives Esophageal cancer is a high-mortality disease. Esophagectomy is the most effective method to treat esophageal cancer, accompanied with a high incidence of post-operation complications. The anastomosis has a close connection to many severe post-operation complications. However, it remains controversial about the choice of intrathoracic anastomosis (IA) or cervical anastomosis (CA). The study was conducted to compare the clinical outcomes between the two approaches. Methods We searched databases for both randomized controlled trials (RCTs) and cohort studies comparing post-operation outcomes between IA and CA. Primary outcomes were the incidences of anastomotic leakage and mortality. Secondary outcomes were the incidences of anastomotic stenosis, pneumonia and re-operation. Results Twenty studies with a total of 7,479 patients (CA group: n = 3,183; IA group: n = 4296) were included. The results indicated that CA group had a higher incidence of anastomotic leakage than IA group (odds ratio [OR] = 2.05, 95% confidence intervals [CI] = 1.61–2.60, I2 = 53.31%, P

Background: Esophageal squamous cell carcinoma (ESCC) is a prevalent and aggressive gastrointestinal tumor, particularly in East Asia. However, there is a lack of consensus on the long-term survival outcomes of intrathoracic anastomosis and cervical anastomosis following esophagectomy. This study aims to provide a comprehensive summary of the long-term survival outcomes of these two anastomosis techniques., Methods: We employed data drawn from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database from January 2010 to December 2017. Patients were stratified into two distinct groups according to the anatomical location of anastomosis following esophagectomy: those who underwent intrathoracic anastomosis (IA Group) and those who underwent cervical anastomosis (CA Group). To account for potential confounding factors and baseline imbalances between the two groups, propensity score matching (PSM) was employed., Results: The CA Group exhibited longer OS compared to the IA Group, with a median OS of 49.10 months versus 35.87 months (HR,1.118; 95% CI: 1.118-1.412; P < 0.001) . Additionally, survival rates at 1-, 3-, and 5-years were higher in the CA Group (87%, 59%, and 48% respectively) compared to the IA Group (86%, 50%, and 39% respectively). The significance persisted even after propensity score matching (PSM) (HR: 1.164; 95% CI: 1.013-1.336; P < 0.001), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were applied. The survival difference between CA and IA was attributed to varying extents of lymph node dissection, particularly in the upper mediastinal zone (P < 0.001)., Conclusions: In conclusion, our study suggests that there could be the potential survival advantage of CA over IA in patients undergoing esophagectomy for ESCC., (Copyright © 2024. Published by Elsevier Inc.)