A novel technique for cervical gastro-oesophageal anastomosis during minimally invasive oesophagectomy

Background: Current evidence on the benefits of different anastomotic techniques (hand-sewn (HS), circular stapled (CS), triangulating stapled (TS) or linear stapled/semimechanical (LSSM) techniques) after oesophagectomy is conflicting. The aim of this study was to evaluate the evidence for the techniques for oesophagogastric anastomosis and their impact on perioperative outcomes. Methods: This was a systematic review and network meta-analysis. PubMed, EMBASE and Cochrane Library databases were searched systematically for randomized and non-randomized studies reporting techniques for the oesophagogastric anastomosis. Network meta-analysis of postoperative anastomotic leaks and strictures was performed. Results: Of 4192 articles screened, 15 randomized and 22 non-randomized studies comprising 8618 patients were included. LSSM (odds ratio (OR) 0⋅50, 95 per cent c.i. 0⋅33 to 0⋅74; P = 0⋅001) and CS (OR 0⋅68, 0⋅48 to 0⋅95; P = 0⋅027) anastomoses were associated with lower anastomotic leak rates than HS anastomoses. LSSM anastomoses were associated with lower stricture rates than HS anastomoses (OR 0⋅32, 0⋅19 to 0⋅54; P < 0⋅001). Conclusion: LSSM anastomoses after oesophagectomy are superior with regard to anastomotic leak and stricture rates.

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“…1 ). Details of these studies 15–18,32–67 are shown in Table 1 . The majority of included studies reported on open oesophagectomy.…”

Section: Resultsmentioning

confidence: 99%

Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

et al. 2020

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“…Once it occurs, patients suffered decreased quality of life, protracted hospitalization or even death. This is why there were many innovations and modifications in reconstructive surgery including functional end-to-end stapling, triangulating stapling, T-shaped linear stapling, pre-embedded stapling, and so forth (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…Although efficacy of mechanical anastomosis had been reported previously ( 12 , 16 , 17 ), much effort had still been tried to better off the clinical outcome and simplify the procedure ( 18 , 19 ). Chen et al ( 20 ) reported that use of pleural flaps in the upper mediastinum would reduce the incidence of cervical subcutaneous emphysema and anastomotic leakage into pleural cavity.…”

Section: Introductionmentioning

confidence: 99%

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

et al. 2021

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The present study aimed to introduce a novel method of cervical esophagogastric anastomosis, so-called 'modified one-piece mechanical anastomosis' (MOMA) in McKeown esophagogastrectomy and to compare its feasibility, efficacy and safety with those of 'conventionally double-layer hand-sewn anastomosis' (CDHA). Between March 2016 and March 2018, 80 consecutive patients with thoracic esophageal squamous cell carcinoma undergoing McKeown esophagogastrectomy with a curative intent were included in the present study. Among them, 40 received MOMA and the other 40 received CDHA. Their medical records, including operation time, anastomotic time, estimated blood loss, postoperative complications within 30 days, as well as survival rate, were retrospectively reviewed, analyzed and compared. Total operation time, anastomotic time and estimated blood loss in the MOMA group were significantly decreased compared with those in the CDHA group (207.73±2.66 vs. 225.40±3.43 min; 10.95±0.44 vs. 23.03±0.47 min; 144.50±21.14 vs. 241.75±23.75 ml; all P<0.01). Anastomotic leakage was present in 1 patient in the CDHA group, but no patients in the MOMA group (P=1.000). Anastomotic stenosis was documented in 4 and 2 patients in the MOMA and CDHA group, respectively (P=0.392). The 30-day operative mortality was 0% and no significant difference was demonstrated in postoperative complications within groups (P>0.05). Furthermore, the disease-free and overall survival was compared by means of Kaplan-Meier survival estimates and log-rank tests and no statistical difference was determined (P=0.5114 and P=0.7875, respectively). McKeown esophagogastrectomy with MOMA may be a feasible, effective and reproducible alternative with relatively satisfactory postoperative outcomes for the treatment of TE-SCC, providing shorter operation and anastomosis times, and less estimated intraoperative blood loss.

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“…In terms of causes and preventive measures of postoperative complications, especially anastomotic leakage, some scholars have made many attempts to find the answer. [8][9][10][11] Previous studies showed that delayed gastric emptying (gastric-tube bloating) after esophagectomy was related to the occurrence of anastomotic leakage and gastric perforation, and the possible reason was that gastric-tube dilatation and the gravitational effect on the stomach without pleural fixation increased the tension on the anastomosis. [12][13][14] Asteriou et al 15 reported that suturing the mobilized pleura over the completed anastomosis could reduce anastomotic leakage after Ivor-Lewis esophagogastrectomy.…”

Section: Introductionmentioning

confidence: 99%

“…In the concept of ERAS system, reducing postoperative complications is an important task. In terms of causes and preventive measures of postoperative complications, especially anastomotic leakage, some scholars have made many attempts to find the answer 8–11 . Previous studies showed that delayed gastric emptying (gastric‐tube bloating) after esophagectomy was related to the occurrence of anastomotic leakage and gastric perforation, and the possible reason was that gastric‐tube dilatation and the gravitational effect on the stomach without pleural fixation increased the tension on the anastomosis 12–14 .…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of upper mediastinal pleura reduces postoperative complications in enhanced recovery surgery system after esophagectomy: A propensity score matching study

Chen

Xie

et al. 2021

Journal of Surgical Oncology

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Objectives: This study aimed to explore the effect of suturing upper mediastinum pleura on postoperative complications, surgery-related mortality, and hospital stay.Methods: Four hundred and thirty-eight patients with esophageal cancer who underwent esophagectomy were identified. Patients were divided into two groups: those in the test group who received reconstruction of upper mediastinal pleura, those in the conventional group who did not. The incidence of postoperative complications, surgery-related mortality, and hospital stay were compared. To reduce the impact of confounding factors, a propensity score matching (PSM) method was performed.Results: A total of 273 patients were treated with suturing upper mediastinal pleura and 165 were not. After PSM, compared with the conventional group, the incidence of atelectasis (7.2% vs. 1.4%, p = 0.035), anastomotic leakage (5.8% vs. 0.7%, p = 0.036), and delayed gastric emptying (10.8% vs. 3.6%, p = 0.034) were significantly lower in the test group. And suturing the upper mediastinal pleura could reduce the severity of leakage (p = 0.045), consistent with the results before PSM.Moreover, there were no significant differences in the incidence of other complications, postoperative hospital stay, and 30-day mortality (all p > 0.05).Conclusions: In this study, suturing the upper mediastinal pleura can reduce the incidence of atelectasis, anastomotic leakage, and delayed gastric emptying, and the severity of leakage, without increasing the incidence of other complications, surgeryrelated death, and postoperative hospital stay.

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A novel technique for cervical gastro-oesophageal anastomosis during minimally invasive oesophagectomy

Abstract: Jiang's anastomosis technique remarkably reduces the incidence of gastro-oesophageal anastomotic leakage, stricture and reflux, and it is a safe and effective technique for minimally invasive oesophagectomy.

Cited by 11 publications

References 22 publications

Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

Reconstruction of upper mediastinal pleura reduces postoperative complications in enhanced recovery surgery system after esophagectomy: A propensity score matching study

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