关于新辅助治疗对食管切除术后吻合口漏 (AL) 影响的报道存在相互矛盾的结果。我们的目的是通过网络荟萃分析揭示新辅助治疗对食管切除术后 AL 的潜在影响。通过检索 PubMed、EMbase、The Cochrane Library 和 Web of Science Core Collection 的相关文献进行贝叶斯网络荟萃分析。比较以下治疗方式的随机临床试验 (RCT) 和回顾性研究 (RS) 包括：新辅助放化疗 (nCRT)、新辅助化疗 (nCT)、新辅助放疗 (nR)、新辅助免疫化疗 (nICT) 和单纯手术 (SA) 。还根据辐射剂量、检查的淋巴结（ELN）、重建途径、吻合部位和手术方式进行亚组分析。本研究共纳入 62 项研究，共 12,746 名患者，其中 17 项为随机对照试验。两项 RCT 的 AL 的五种治疗方式之间没有观察到显着的统计差异（nCRT-nICT：风险比 1.51，95% 置信区间 0.52-4.4；nCT-nICT：1.71、0.56-5.08；nICT-nR：0.79， 0.12-8.02；nICT-SA：0.59、0.2-1.84）和 RS（nCRT-nICT：比值比 1.53，95% 置信区间 0.84-2.84；nCT-nICT：1.56、0.87-2.88；nICT-SA：0.6、0.31 -1.12；nICT-nR：1.08，0.09-36.02）。亚组分析显示，除了辐射剂量≥41.4 Gy 时 nCRT 与 nCT (0.21, 0.05-0.73) 对 AL 的影响外，五种治疗方式中未观察到 AL 的显着差异。新辅助治疗不会显着增加 AL 的发生率食管切除术后的 AL。中等剂量的照射与 AL 风险升高无关。临床医生可以不再那么担心开 nCRT。© 2024 作者。中国科克伦中心、四川大学华西医院和John Wiley联合出版的《Journal of Evidence-Based Medicine》

Conflicting results have been reported about the impact of neoadjuvant therapy on anastomotic leakage (AL) after esophagectomy. We aimed to unravel the potential effect of neoadjuvant therapy on AL after esophagectomy through a network meta-analysis.A Bayesian network meta-analysis was performed by retrieving relevant literature from PubMed, EMbase, The Cochrane Library and Web of Science Core Collection. Randomized clinical trials (RCTs) and retrospective studies (RS) comparing the following treatment modalities were included: neoadjuvant chemoradiation (nCRT), neoadjuvant chemotherapy (nCT), neoadjuvant radiotherapy (nR), neoadjuvant immunochemotherapy (nICT), and surgery alone (SA). Subgroup analyses by radiation dose, examined lymph nodes (ELN), route of reconstruction, site of anastomosis, and surgical approach were also conducted.A total of 62 studies with 12,746 patients were included for the present study, among which 17 were RCTs. There were no significantly statistical differences observed among the five treatment modalities in AL for both RCTs (nCRT-nICT: risk ratio 1.51, 95% confidence interval 0.52-4.4; nCT-nICT: 1.71, 0.56-5.08; nICT-nR: 0.79, 0.12-8.02; nICT-SA: 0.59, 0.2-1.84) and RS (nCRT-nICT: odds ratio 1.53, 95% confidence interval 0.84-2.84; nCT-nICT: 1.56, 0.87-2.88; nICT-SA: 0.6, 0.31-1.12; nICT-nR: 1.08, 0.09-36.02). Subgroup analysis revealed that no significant difference in AL was observed among the five treatment modalities except for the impact of nCRT versus nCT (0.21, 0.05-0.73) on AL with a radiation dose ≥41.4 Gy.Neoadjuvant therapy do not significantly increase the incidence of AL after esophagectomy. Administration of irradiation with a moderate dose is not associated with elevated risk in AL. Clinicians can be less apprehensive about prescribing nCRT.© 2024 The Author(s). Journal of Evidence‐Based Medicine published by Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.