Circular vs. linear stapling after minimally invasive and robotic-assisted esophagectomy: a pooled analysis

Abstract

Purpose Current data states that most likely there are differences in postoperative complications regarding linear and circular stapling in open esophagectomy. This, however, has not yet been summarized and overviewed for minimally invasive esophagectomy, which is being performed increasingly. Methods A pooled analysis was conducted, including 4 publications comparing linear and circular stapling techniques in minimally invasive esophagectomy (MIE) and robotic-assisted minimally invasive esophagectomy (RAMIE). Primary endpoints were anastomotic leakage, pulmonary complications, and mean hospital stay. Results Summarizing the 4 chosen publications, no difference in anastomotic insufficiency could be displayed (p = 0.34). Similar results were produced for postoperative pulmonary complications. Comparing circular stapling (CS) to linear stapling (LS) did not show a trend towards a favorable technique (p = 0.82). Some studies did not take learning curves into account. Postoperative anastomotic stricture was not specified to an extent that made a summary of the publications possible. Conclusions In conclusion, data is not sufficient to provide a differentiated recommendation towards mechanical stapling techniques for individual patients undergoing MIE and RAMIE. Therefore, further RCTs are necessary for the identification of potential differences between LS and CS. At this point in research, we therefore suggest evading towards choosing a single anastomotic technique for each center. Momentarily, enduring the learning curve of the surgeon has the greatest evidence in reducing postoperative complication rates.

Fully Robotic Side‐to‐Side Linear‐Stapled Anastomosis During Robotic Ivor Lewis Esophagectomy

“…3 At least theoretically, the configuration itself of the anastomosis may have some advantages due to a wider distribution of shear stress along both longitudinal and transversal lines over the anastomotic tissues evidence supporting one technique over another [6][7][8]11]. However, albeit predominantly based on open esophagectomy, current data reveal that stapling techniques seem to result in lower incidence of anastomotic leakage compared to hand-sewn anastomoses [4,11,13].…”

“…The circular stapling technique is currently the predominantly employed and standardized reconstruction during RAMIE, adopting the method standardized in conventional open and thoracoscopic surgery [2, 4, 7, 8, 12, 13]. Although relatively easy to learn, the stapler needs to be introduced in the chest via a minithoracotomy by the bedside assistant, who has to maneuver it in coordination with the operating surgeon at the console.…”

“…Which technique for intrathoracic anastomosis during MIE (and RAMIE in particular) should be considered optimal is still to be defined, essentially due to the lack of high‐level evidence supporting one technique over another [6–8, 11]. However, albeit predominantly based on open esophagectomy, current data reveal that stapling techniques seem to result in lower incidence of anastomotic leakage compared to hand‐sewn anastomoses [4, 11, 13].…”