A Comparison of the Postoperative Outcomes Between Intraoperative Leak Testing and Non-Intraoperative Leak Testing for Gastric Cancer Surgery: A Systematic Review and Meta-analysis

Purpose: Postoperative anastomotic leakage (PAL) is a serious complication of gastric cancer surgery. Although perioperative management has made significant progress, anastomotic leakage (AL) cannot always be prevented. Intraoperative leak testing (IOLT) may reduce the incidence of PAL and other postoperative complications. The aim of this study is to assess the relationship between IOLT and postoperative surgical complications 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. Studies comparing the postoperative outcomes of IOLT and non-intraoperative leak testing (NIOLT) were included. Quality assessment, heterogeneity, risk of bias, and the level-of-evidence of the inclusions were evaluated. PAL, anastomosis-related complications, 30-day mortality, and reoperation rates were compared between the IOLT and NIOLT group. Results Our literature search returned 975 results, from which 3 trials (929 total patients) were included in our meta-analysis. Statistical heterogeneity was low. The primary outcome was PAL. IOLT statistically reduced the risk of PAL [3.08% vs9.54%; risk ratios (RR) 0.336, 95% CI, 0.189–0.600, P = 0.000]. It was also found that IOLT can lower the incidence of other postoperative outcomes. Anastomosis-related complication rates [3.94% vs13.14%; risk ratios (RR) 0.323, 95% CI, 0.182–0.572, P = 0.000] were significantly higher in the NIOLT group than the IOLT group. Moreover, IOLT was associated with lower reoperation rates [2.36% vs9.14%; risk ratios (RR) 0.301, 95% CI, 0.145–0.621, P = 0.001]. Conclusion Due to the lower incidence of PAL, anastomosis-related complications, and reoperation rates, IOLT is recommended in gastric cancer surgery.