Comparison of the outcomes between total eversion and conventional triangulating stapling technique in cervical esophagogastric anastomosis after esophagectomy: a propensity score-matched analysis

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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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References

  1. 1.

    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.

    CAS  Article  Google Scholar 

  2. 2.

    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.

    Article  Google Scholar 

  3. 3.

    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.

    Article  Google Scholar 

  4. 4.

    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.

    CAS  Article  Google Scholar 

  5. 5.

    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.

    PubMed  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 7.

    Takemura M, Yoshida K, Fujiwara Y. Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc. 2013;27(4):1249–53.

    Article  Google Scholar 

  8. 8.

    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.

    Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    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.

    Article  Google Scholar 

  11. 11.

    Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    CAS  Article  Google Scholar 

  12. 12.

    Beitler AL, Urschel JD. Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg. 1998;175(4):337–40.

    CAS  Article  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    Rice TW. Anastomotic stricture complicating esophagectomy. Thorac Surgery Clin. 2006;16(1):63–73.

    Article  Google Scholar 

  15. 15.

    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.

    Article  Google Scholar 

  16. 16.

    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.

    CAS  Article  Google Scholar 

  17. 17.

    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.

    CAS  PubMed  Google Scholar 

  18. 18.

    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.

    Article  Google Scholar 

  19. 19.

    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.

    CAS  Article  Google Scholar 

  20. 20.

    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).

    CAS  Article  Google Scholar 

  21. 21.

    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.

    Article  Google Scholar 

  22. 22.

    Ngan SY, Wong J. Lengths of different routes for esophageal replacement. J Thorac Cardiovasc Surg. 1986;91(5):790–2.

    CAS  Article  Google Scholar 

  23. 23.

    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.

    CAS  Article  Google Scholar 

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Correspondence to Masayuki Watanabe.

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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

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Keywords

  • Esophagectomy
  • Triangulating stapling technique
  • Anastomotic stenosis