Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

Abstract

Objective: This study was performed to investigate the efficacy of the modified Collard (MC) technique for reducing anastomotic stricture after esophagectomy compared with the circular stapled (CS) technique. Summary Background Data: The currently available techniques of anastomosis after esophagectomy are associated with a significant risk of anastomotic complications. However, the optimal anastomotic technique after esophagectomy has not yet been established. Methods: We randomly allocated patients to either the CS group or the MC group. The primary endpoint was the incidence of anastomotic stricture. The secondary endpoints included the incidence of postoperative complications (including anastomotic leakage) and quality of life (QoL). All anastomoses were performed after indocyanine green evaluation for objective homogenization of blood flow to the gastric conduit between the 2 techniques. Results: Among 100 randomized patients (CS group, n ¼ 50; MC group, n ¼ 50), anastomotic strictures were observed in 18 (42%) patients in the CS group and in no patients in the MC group. There were no significant between-group differences in anastomotic leakage (CS group, 7% vs MC group, 8%; P ¼ 0.94). Quality of life domains of dysphagia and choking when swallowing at 3 months after surgery were significantly better in the MC group than in the CS group. Conclusions: The MC technique reduces the incidence of anastomotic stricture and improves postoperative quality of life. Furthermore, the incidence of anastomotic leakage is comparable between the 2 techniques based on accurate comparison under objective homogenization of the gastric conduit condition.

Linear- versus circular-stapled esophagogastric anastomosis during esophagectomy: systematic review and meta-analysis

“…This is similar to what previously reported by Zhou et al that acknowledged a significant tendency toward reduced stricture risk for LS (RR = 0.26; p = 0.002) [63]. Similar results are reported by several retrospective analyses [32,37,44]. Possible explanations include a wider anastomotic diameter and reduced risk of staple line scarring/fibrosis for LS.…”

“…This may be attributable to the increased utilization of proton pump inhibitors to reduce acid production and esophageal exposure. This is different from Hosoi et al that affirmed a tendency toward higher rates of esophagitis for LS anastomosis [44]. Finally, no significant differences were found for postoperative pneumonia, 30-day mortality, OT, and HLOS.…”

“…19%) [37]. Despite the lack of statistical significance, Fabbi et al [46] and Hosoi and colleagues [44] reported a tendency toward reduced AL for LS. In contrast, Zhou et al in a 2015 meta-analysis affirmed no differences for postoperative AL comparing LS vs. CS (RR = 0.80; p = 0.52) [63].…”