Comparison of Hand-sewn and Modified Mechanical Anastomosis in Esophageal Cancer Patients Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

Abstract

Background: There are controversies over the efficacy of mechanical stapler when compared with the hand-sewn (HS) technique in patients who underwent esophagogastric anastomosis in terms of efficacy and post-operative advantages. The purpose of the present study is to compare the clinical outcomes of manual and a modified mechanical stapled (MMS) anastomosis (double stapled technique) during esophagectomy for esophageal cancer.Methods: A retrospective cohort study was conducted on 409 patient’s medical records who underwent transhiatal esophagectomy for esophageal cancer between March 2010 and March 2016. All patients were operated using HS technique or MMS technique. All cases were visited in two weeks, four, eight and twelve months after surgery and were evaluated in terms of postoperative complications including anastomotic leakage, regurgitation, anastomotic stricture, dysphagia and need for anastomotic dilatation.Results: 259 (63.3%) patients were operated using HS technique and 150 patients (36.7%) were operated by MMS technique. The mean operative time was 211.45± 82.25 min for the MMS anastomosis group, whereas for the manual group it was 251.42±52.81 min, respectively (P = 0.023). Postoperatively, 38 (14.67%) anastomotic leakage were detected in the HS group compared to 8 (5.33%) the MMS group (P= 0.002). The results showed lesser anastomotic stricture in patients who underwent MMS anastomosis (P= 0.004). However, during the one-year follow-up period, patients with HS anastomosis required more anastomotic dilatation (P= 0.021).Conclusions: Using a MMS anastomosis may reduce operation time and lead to lower rates of anastomotic leak, decrease anastomotic stricture and anastomotic dilatation.