{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:24:32Z","timestamp":1778891072211,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T00:00:00Z","timestamp":1507680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T00:00:00Z","timestamp":1507680000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Indications for surgery and clinical outcomes of esophagectomy in the management of end\u2010stage achalasia are not clearly defined. The aim of this systematic review and meta\u2010analysis was to provide evidence\u2010based information to help in the decision\u2010making and in the choice of surgical technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An extensive literature search was conducted to identify all reports on esophagectomy for end\u2010stage achalasia patients over the past three decades. MEDLINE, Embase and Cochrane databases were thoroughly consulted matching the terms \u201cachalasia,\u201d \u201cend\u2010stage achalasia,\u201d \u201cesophagectomy\u201d and \u201cesophageal resection\u201d with \u201cAND\u201d and \u201cOR.\u201d Short\u2010 and long\u2010term outcome data were extracted. Pooled prevalence of pneumonia, anastomotic leakage and mortality were calculated using Freeman\u2013Tukey double arcsine transformation and DerSimonian\u2013Laird estimator in random effect meta\u2010analysis. Heterogeneity among studies was evaluated using <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2010index and Cochrane <jats:italic>Q<\/jats:italic> test. Meta\u2010regression was used to address the effect of potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight papers published between 1989 and 2014\u00a0matched the inclusion criteria. In total, 1307 patients were included. Esophagectomy was performed through a transthoracic (78.7%) or a transhiatal (21.3%) approach. The stomach was used as an esophageal substitute in 95% of patients. Pooled prevalence of pneumonia, anastomotic leakage and mortality were 10% (95% CI 4\u201318%), 7% (95% CI 4\u201310%) and 2% (95% CI 1\u20133%), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Esophagectomy for end\u2010stage achalasia is safe and effective. Based on the results of this study, esophagectomy should be performed without hesitation in patients who are fit for major surgery and present with disabling symptoms, poor quality of life and dolichomegaesophagus recalcitrant to multiple endoscopic dilatations and\/or surgical myotomies.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4298-7","type":"journal-article","created":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T19:19:25Z","timestamp":1507749565000},"page":"1469-1476","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Esophagectomy for End\u2010Stage Achalasia: Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","volume":"42","author":[{"given":"Alberto","family":"Aiolfi","sequence":"first","affiliation":[{"name":"Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato University of Milan Piazza Edmondo Malan, 1 20097 San Donato Milanese MI Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Asti","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato University of Milan Piazza Edmondo Malan, 1 20097 San Donato Milanese MI Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Bonitta","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato University of Milan Piazza Edmondo Malan, 1 20097 San Donato Milanese MI Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4880-1670","authenticated-orcid":false,"given":"Luigi","family":"Bonavina","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato University of Milan Piazza Edmondo Malan, 1 20097 San Donato Milanese MI Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,10,11]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1052-5157(18)30068-0"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/dox072"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(13)60651\u20100"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31818e43ab"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.10.023"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102015\u2010310602"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2004.30199.x"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010015\u20103012\u2010x"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654\u2010010\u20109491\u2010z"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177729756"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.2307\/2682942"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197\u20102456(86)90046\u20102"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/26.4.404"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/9780470743386"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.6"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_6_19_2","unstructured":"R Development Core Team(2015)A language and environment for statistical computing. 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