Table 2 Details of included studies

Cikot

49

42

ND

5 days after surgery

(3 month follow up for patients with AL)

AL diagnosis was based on rectal or oral contrast-induced tomography, laboratory results, and patients’ clinical findings.

5 days after surgery

Clavien-

Dindo classification

Metronidazole and ceftriaxone after operation

Patients with systemic or local infection were excluded.

Preoperatively: enoxaparin and ceftriaxone Postoperatively:

Enoxaparin, hydrochloride, ranitidine, hydration, and tenoxicam

IIIa: 30%

IIIb:

15%

IVa: 22%

IVb:7%

V: 26%

ND

Paliogiannis

65.8

57

25.1

within 30 days from surgery

Imaging or endoscopic techniques

within 30 days from surgery

Clavien-Dindo classification

1) Surgical operation (72% of cases)

2) Without surgical approach

Patients under the age of 18, those who had emergency surgery, and those without an anastomosis were excluded.

ND

ND

AJCC staging:

0: 1%

I: 17%

II: 33%

III: 37%

IV:12%

Grading:

1:13.5%

2:71.5%

3: 15%

Radulescu1

67.75

61.8

ND

ND

ND

ND

ND

ND

Exclusion criteria:

1) Patients with autoimmune diseases and systemic inflammation

2) Those who stopped their oncological regimen

3) Those on long-term systemic anti-inflammatory medication

4) Those with concurrent cancers and secondary disseminations

5) Patients who had emergency surgery

Preoperative:

1) protein or electrolytic equilibration

2) Rehydration

3) chemotherapy, radiotherapy, or both

ND

Stage:

I: 12%

II: 32%

III: 46%

IV: 10%

Radulescu2

68.19

64.59

ND

ND

ND

ND

ND

ND

Exclusion criteria:

Metastases, concurrent cancer, long-term anti-inflammatory medication, autoimmune disorders, incomplete oncological treatment, and systemic inflammation.

Preoperative:1) Hydroelectrolytic or protein balancing treatment;

2) Chemotherapy, radiotherapy or combined treatment

ND

Stage:I: 10.5%

II: 34%

III:43.5%

IV: 12%

Romano

45

36.42%

40.48

5.12

1) Radiography

2) Computed tomography scan

7.16 days after surgery

Dindo-Clavien classification

1) Double pigtail drainage insertion (endoscopically)

2) Drainage (radiologically)

3) Laparoscopic surgical toilette

Participants had comorbidities like Obstructive sleep apnea, Hypertension, type 2 DM, and Dyslipidemia.

Prior surgery, a multidisciplinary team consisting of a nutritionist, psychologist, gastroenterologist, and endocrinologist assessed each patient and monitored them for a minimum of 6 months.

ND

ND

Sato

69.75

88

21.68

7 days after surgery

1) Radiographic contrast study

2) CT

3) clinical findings

Formation of pus, luminal contents, or saliva via wound site accompanied with fever, local inflammation, and leukocytosis were considered indicators of a clinical leak.

Contrast extravasation while the contrast study was classified as a radiologic leak. According to the radiologist, a leak in CT was described as the emergence of effusion and free gas at the anastomosis site.

6.6 days postoperatively

Esophageal Complications Consensus Group definitions AND Clavien-Dindo classification

1) Monitoring without food intake orally followed 1 week later by a second contrast exam to demonstrate healing

2) Drainage from the neck under local anesthesia

3) Antibiotic therapy

4) Mediastinal drainage under general anesthesia.

Pts had comorbidities including DM, hypertension, and COPD.

Exclusion criteria: 1) Pts who underwent laryngopharyngectomy, esophagectomy, salvage esophagectomy, esophagectomy without reconstruction, reconstruction from the posterior mediastinal route, synchronous colonic or liver cancer surgery reconstruction using colon or jejunum as a conduit

2) Pts who died within 5 days after surgery due to bleeding, cardiovascular events, or unknown causes.

1) Endoscopic submucosal dissection

2) Chemoradiotherapy

3) Chemotherapy

ND

IA-IIB:

55%

IIIA-IV:

45%

Suzuki

68

59.6%

21.4

44(14–89)

AL was diagnosed based on the following clinical signs: pus or stool discharge from the abdomen drain, peritonitis with tachycardia, high fever, tenderness, abdominal pain, or severe inflammation. If an abscess, free air, or fluid collection was detected around the anastomotic site, CT was used to determine the existence of AL. Asymptomatic AL, on the other hand, was difficult to evaluate since contrast enemas were not commonly performed.

ND

ND

1) re-operation

2) reconstruction of a covering stoma, and performed intraabdominal lavage and drainage

3) drainage with an abdominal drain.

Pts who had surgery utilizing alternative procedures (Hartmann’s Operation, transanal operation, Miles’ operation, total pelvic extirpation, and others) were excluded.

In complicated situations, such as tumors with extramural invasion or bulky tumors, preoperative chemotherapy or chemoradiotherapy was provided. As part of the standard preoperative evaluation for rectal surgery, a pelvic CT scan was conducted on all patients.

ND

UICC-stage:

0: 1%

I: 45%

II: 12%

III: 29%

IV: 13%

Yuliandar

53.37

57%

ND

ND

During re-surgery.

ND

ND

ND

Exclusion criteria:

1) Surgery without anastomosis (palliative stoma, Hartmann procedure, by-pass anastomosis)

2) Primary anastomosis with a protective stoma

ND

ND

ND

Huang

Neonates

69

ND

ND

ND

ND

ND

ND

Participants had comorbidities including

respiratory, genitourinary,

gastrointestinal, musculoskeletal, and congenital cardiovascular anomalies.

Nonetheless, individuals who were unable to undergo delayed anastomosis during the first phase of the operation were excluded.

ND

ND

ND

Li

60.37

91

21.92

35.26

Fluoroscopic esophagography

7 to 14 days after surgery

ND

ND

Participants had comorbidities including

Smoking, DM, alcohol consumption, and hypertension. However, patients whose diagnosis was malignant melanoma, adenocarcinoma, gastrointestinal stromal tumor, small cell carcinoma, and malignant neuroendocrine tumor; and individuals who did not get an abdominal CT scan 2 weeks prior to surgery; and patients with proven metastases prior to surgery were excluded.

ND

ND

T stage:

T1-T2:

42%

T3-T4:

58%

Rodriguez

61.5

37.9

ND

17.43

1) clinical or imaging indications of luminal leakage around the EJ

2) Inclusion of intestinal saliva or contents in perianastomotic drains,

3) presence of extraluminal contrast material in imaging investigations or fluid collections close to the EJ in CT scan or ultrasound.

within 1 week of operation

ND

supportive treatment

including:

1) intravenous hydration

2) nothing by mouth

3) antibiotics

4) fluid collection drainage

with interventional techniques

Participants had comorbidities including hypothyroidism, dyslipidemia, type 2 diabetes, and Hypertension.

1) total parenteral nutrition

2) Early feeding as tolerated

ND

ND

Wu

61.3

92.4%

ND

ND

ND

Within 30 days from surgery

ND

ND

Participants had comorbidities including DM, hypertension, and Lung disease.

Patients with the following criteria were excluded:

1) Older than 80 and younger than 18

2) Active hepatic, cardiac, or renal disease

3) Chronic infection, distant metastasis, and concurrent malignancy

4) Received radiotherapy or neoadjuvant chemotherapy

5) People who underwent emergency surgery or admitted to intensive care unit after surgery

6) Those who had difficulty expelling sputum following surgery

ND

ND

AJCC stage:

I: 6%

II: 35%

III: 56%

IV: 3%