Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesophagogastric anastomosis: single-centre analysis of 415 oesophagectomies

Harustiak, Tomas; Pazdro, A; Snajdauf, Martin; Stolz, A; Lischke, Robert

doi:10.1093/ejcts/ezv395

Cited by 61 publications

(50 citation statements)

References 25 publications

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“…Other randomized controlled trials revealed a higher prevalence of anastomotic leakage and anastomotic stricture in manually operated individuals, suggesting the superiority of mechanical anastomosis as a technique for esophagogastric anastomotic construction (23)(24)(25). Even in intrathoracic esophagogastric anastomosis where linear stapling is conducted, a signi cant decrease in anastomotic leakage and stricture was observed compared with the levels occurring under hand-sewn anastomosis (19).…”

Section: Discussionmentioning

confidence: 99%

Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

Rasihashemi

Ramouz

Beheshtirouy

et al. 2020

Preprint

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Background: Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients.Methods: This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in two weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation.Results: Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46±84.33 min and 250.55±43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02).Conclusion: Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

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Section: Discussionmentioning

confidence: 99%

Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

Rasihashemi

Ramouz

Beheshtirouy

et al. 2020

Preprint

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“…Mechanical anastomosis mainly consists of circular stapled anastomosis and linear stapled anastomosis (including delta‐shaped anastomosis) . Compared with hand‐sewn anastomosis, linear stapled anastomosis can greatly reduce the incidence of anastomotic fistula and anastomotic stricture . However, this type of anastomosis requires the esophageal stump to be dissociated long enough to enable the insertion of the linear stapler, which is difficult to achieve in patients with a short neck or higher tumor location when performing cervical anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…13 Compared with hand-sewn anastomosis, linear stapled anastomosis can greatly reduce the incidence of anastomotic fistula and anastomotic stricture. 14,15 However, this type of anastomosis requires the esophageal stump to be dissociated long enough to enable the insertion of the linear stapler, which is difficult to achieve in patients with a short neck or higher tumor location when performing cervical anastomosis. Additionally, the anastomotic stoma made by linear stapled anastomosis is too large, which can easily cause gastroesophageal reflux.…”

Section: Discussionmentioning

confidence: 99%

Pre‐embedded cervical circular stapled anastomosis in esophagectomy

Wang

Liang

et al. 2020

Thoracic Cancer

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Background Mechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications. Methods In total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre‐embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Results The results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205–300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8–14 days with an average of 10.3 days. Conclusion Our data revealed that pre‐embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma. Key points This new technique can significantly reduce the risk of anastomotic leakage. This study adds further details enabling a smooth pre‐embedded procedure to be performed.

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“…Patients with resectable disease underwent either a transthoracic oesophagectomy with gastric pull‐up reconstruction (Ivor Lewis procedure) or a total or proximal gastrectomy, depending on the location and extent of the tumour. Details of the authors' surgical technique for the Ivor Lewis procedure have been described previously. Abdominal lymph node dissection was a part of all radical operations, and infracarinal mediastinal lymphadenectomy was added to transthoracic oesophagectomy.…”

Section: Methodsmentioning

confidence: 99%

[18F]Fluorodeoxyglucose PET/CT and prediction of histopathological response to neoadjuvant chemotherapy for adenocarcinoma of the oesophagus and oesophagogastric junction

Harustiak

Zemanová

Fencl

et al. 2018

British Journal of Surgery

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Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesophagogastric anastomosis: single-centre analysis of 415 oesophagectomies

Abstract: Our non-randomized study showed that side-to-side LS technique is the preferred method of intrathoracic oesophagogastric anastomosis due to a decreased overall anastomotic leak rate and anastomotic stricture formation compared with HS technique.

Cited by 61 publications

References 25 publications

Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

Pre‐embedded cervical circular stapled anastomosis in esophagectomy

[18F]Fluorodeoxyglucose PET/CT and prediction of histopathological response to neoadjuvant chemotherapy for adenocarcinoma of the oesophagus and oesophagogastric junction

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