Anastomotic leakage and stenosis remain major problems after esophageal reconstruction. This study evaluated the clinical outcomes between the total eversion (TE) triangulating stapling technique (TST) and conventional (C) TST.
The study included 404 consecutive patients with esophageal cancer who underwent cervical esophagogastrostomy by TST between January 2013 and December 2018. The postoperative outcomes were compared between TE-TST and C-TST using propensity score-matched analysis.
Before matching, the cT stage and the cTNM stage were different between the groups. After matching, each group consisted of 128 patients. The patients’ background characteristics were similar between the groups. Although the incidence of anastomotic leakage was similar between the groups (p = 0.216), anastomotic stricture occurred in 19 (14.8%) and 7 (5.5%) patients in the C-TST and the TE-TST groups, respectively (p = 0.021).
The incidence of anastomotic stenosis was significantly lower in the TE-TST group than in the C-TST group. TE-TST decreases the incidence of anastomotic stricture and can improve the quality of life in patients undergoing esophagectomy.
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Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg. 1995;222(5):654–62.
Takeuchi H, Miyata H, Gotoh M, Kitagawa Y, Baba H, Kimura W, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260(2):259–66.
Sugimura K, Miyata H, Matsunaga T, Asukai K, Yanagimoto Y, Takahashi Y, et al. Comparison of the modified Collard and hand-sewn anastomosis for cervical esophagogastric anastomosis after esophagectomy in esophageal cancer patients: a propensity score-matched analysis. Ann Gastroenterol Surg. 2019;3(1):104–13.
Zhou D, Liu QX, Deng XF, Min JX, Dai JG. Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: a meta-analysis. J Cardiothorac Surg. 2015;10:67.
Furukawa Y, Hanyu N, Hirai K, Ushigome T, Kawasaki N, Toyama Y, et al. Usefulness of automatic triangular anastomosis for esophageal cancer surgery using a linear stapler (TA-30). Ann Thorac Cardiovasc Surg. 2005;11(2):80–6.
Toh Y, Sakaguchi Y, Ikeda O, Adachi E, Ohgaki K, Yamashita Y, et al. The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today. 2009;39(3):201–6.
Takemura M, Yoshida K, Fujiwara Y. Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc. 2013;27(4):1249–53.
Yoshida N, Baba Y, Watanabe M, Hiyoshi Y, Ishimoto T, Iwagami S, et al. Triangulating stapling technique covered with the pedicled omental flap for esophagogastric anastomosis: a safe anastomosis with fewer complications. J Am Coll Surg. 2015;220(2):e13–6.
Sobin LH, Compton CC. TNM seventh edition: what’s new, what’s changed: communication from the International Union Against Cancer and the American Joint Committee on Cancer. Cancer. 2010;116(22):5336–9.
Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.
Beitler AL, Urschel JD. Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg. 1998;175(4):337–40.
Toyama Y, Furukawa Y, Kashiwagi H, Ito R, Miyake R, Son K, et al. Completely evarted triangular gastrointestine anastomosis using a linear stapler. Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association). 2006;67(10):2267–72.
Rice TW. Anastomotic stricture complicating esophagectomy. Thorac Surgery Clin. 2006;16(1):63–73.
Takata MC, Ciovica R, Cello JP, Posselt AM, Rogers SJ, Campos GM. Predictors, treatment, and outcomes of gastrojejunostomy stricture after gastric bypass for morbid obesity. Obes Surg. 2007;17(7):878–84.
Petrin G, Ruol A, Battaglia G, Buin F, Merigliano S, Constantini M, et al. Anastomotic stenoses occurring after circular stapling in esophageal cancer surgery. Surg Endosc. 2000;14(7):670–4.
Rossi M, Ancona E, Faccioni C, Galli S, De Caro R. Experimental study on healing of mechanic esophago-gastric sutures: histo-morphologic observations. Il Giornale di chirurgia. 1988;9(11):765–70.
Briel JW, Tamhankar AP, Hagen JA, DeMeester SR, Johansson J, Choustoulakis E, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004;198(4):536–41.
Tanaka K, Makino T, Yamasaki M, Nishigaki T, Miyazaki Y, Takahashi T, et al. An analysis of the risk factors of anastomotic stricture after esophagectomy. Surg Today. 2018;48(4):449–54.
Honkoop P, Siersema PD, Tilanus HW, Stassen LP, Hop WC, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg. 1996;111(6):1141–6 (discussion 7-8).
van Heijl M, Gooszen JA, Fockens P, Busch OR, van Lanschot JJ, van Berge Henegouwen MI. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg. 2010;251(6):1064–9.
Ngan SY, Wong J. Lengths of different routes for esophageal replacement. J Thorac Cardiovasc Surg. 1986;91(5):790–2.
Coral RP, Constant-Neto M, Silva IS, Kalil AN, Boose R, Beduschi T, et al. Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy. Dis Esophagus. 2003;16(3):236–8.
This study was approved by the Cancer Institute Hospital Clinical Research Review Board. The need for informed consent was waived because of the retrospective design of the study.
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Takahashi, K., Watanabe, M., Ushida, Y. et al. Comparison of the outcomes between total eversion and conventional triangulating stapling technique in cervical esophagogastric anastomosis after esophagectomy: a propensity score-matched analysis. Esophagus (2021). https://doi.org/10.1007/s10388-021-00816-2
- Triangulating stapling technique
- Anastomotic stenosis