Abstract
Background
Several techniques have been described for esophagogastric anastomosis following esophagectomy. This study compared the outcomes of circular stapled anastomoses with semi-mechanical technique using a linear stapler.
Methods
Perioperative data were extracted from a contemporaneously collected database of all consecutive esophagectomies for cancer with intrathoracic anastomoses performed in the Trent Oesophago-Gastric Unit between January 2015 and April 2018. Anastomotic techniques: circular stapled versus semi-mechanical, were evaluated and outcomes were compared. The primary outcome was anastomotic leak rate. Secondary outcomes included anastomotic stricture, overall complication rates, length of stay (LOS) and 30 day all-cause mortality.
Results
One hundred and fifty-nine consecutive esophagectomies with intrathoracic anastomosis were performed during the study period. There were no significant differences between the two groups in terms of age, American Society of Anaesthesiologists score, Charlson comorbidity index and neoadjuvant therapies received. Circular stapled anastomoses were performed in 85 patients, while 74 patients received a semi-mechanical anastomosis. Clavien–Dindo complications II or more were higher in the circular stapled group (p = 0.02). There were 16 (10%) anastomotic leaks overall, three (4%) in semi-mechanical group versus 13 (15%) in the circular stapled group (p < 0.019). There was no statistically significant difference between the two groups in terms of LOS, 30-day mortality or the need for endoscopic dilatation of the anastomosis at 3 months follow-up.
Conclusion
The move from a circular stapled to a semi-mechanical intrathoracic anastomosis has been associated with a reduced postoperative anastomotic leak rate following esophagectomy for esophageal cancer.
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References
Dent B et al (2016) Management and outcomes of anastomotic leaks after oesophagectomy. Br J Surg 103(8):1033–1038
Low DE et al (2019) Benchmarking complications associated with esophagectomy. Ann Surg 269(2):291–298
Goense L et al (2019) Impact of postoperative complications on outcomes after oesophagectomy for cancer. Br J Surg 106(1):111–119
Booka E et al (2015) The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine 94(33):e1369
Markar SR, Karthikesalingam A, Low DE (2015) Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis. Dis Esophagus 28(5):468–475
Forshaw MJ et al (2006) Centralisation of oesophagogastric cancer services: can specialist units deliver? Ann R Coll Surg Engl 88(6):566–570
Klevebro F et al (2016) A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction. Ann Oncol 27(4):660–667
Anderson O et al (2011) Hospital volume and survival in oesophagectomy and gastrectomy for cancer. Eur J Cancer 47(16):2408–2414
Low DE et al (2019) Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS((R))) Society Recommendations. World J Surg 43(2):299–330. 10.1007/s00268-018-4786-4
Sjoquist KM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12(7):681–692
Wang DB et al (2016) Neoadjuvant chemoradiotherapy improving survival outcomes for esophageal carcinoma: an updated meta-analysis. Chin Med J 129(24):2974–2982
Honda M et al (2013) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg 257(2):238–248
Casson AG, Porter GA, Veugelers PJ (2002) Evolution and critical appraisal of anastomotic technique following resection of esophageal adenocarcinoma. Dis Esophagus 15(4):296–302
Kondra J et al (2008) A change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus 21(5):422–429
Orringer MB, Marshall B, Iannettoni MD (2000) Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 119(2):277–288
Wang W-P et al (2013) A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg 37(5):1043–1050. 10.1007/s00268-013-1932-x
Varagunam M, P.M., Sinha S, Cromwell D, Maynard N, Crosby T, Trudgill N, National Oesophago-gastric Cancer Audit 2018.
Low DE et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg 262(2):286–294
Avery KN et al (2014) The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer—the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial. Trials 15:200
Rice TW, Patil DT, Blackstone EH (2017) 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg 6(2):119–130
Clavien PA et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Rutegard M et al (2012) Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: a population-based study. Ann Surg Oncol 19(1):99–103
Markar S et al (2015) The impact of severe anastomotic leak on long-term survival and cancer recurrence after surgical resection for esophageal malignancy. Ann Surg 262(6):972–980
Ahmed Z et al (2017) Risk factors for anastomotic stricture post-esophagectomy with a standardized sutured anastomosis. World J Surg 41(2):487–497. 10.1007/s00268-016-3746-0
Collard JM et al (1998) Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg 65(3):814–817
Xu Q-R et al (2011) Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study. J Gastrointest Surg 15(6):915–921
Blackmon SH et al (2007) Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg 83(5):1805–1813 (discussion 1813)
Sepesi B et al (2012) Omental reinforcement of the thoracic esophagogastric anastomosis: an analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy. J Thorac Cardiovasc Surg 144(5):1146–1150
Yuan Y et al (2011) Omentoplasty for preventing anastomotic leaks after esophagogastrostomy. Surgery 149(6):853–854
Mariette C et al (2019) Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 380(2):152–162
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Yanni, F., Singh, P., Tewari, N. et al. Comparison of Outcomes with Semi-mechanical and Circular Stapled Intrathoracic Esophagogastric Anastomosis following Esophagectomy. World J Surg 43, 2483–2489 (2019). https://doi.org/10.1007/s00268-019-05057-0
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DOI: https://doi.org/10.1007/s00268-019-05057-0