Comparison of Outcomes with Semi‐mechanical and Circular Stapled Intrathoracic Esophagogastric Anastomosis following Esophagectomy

Abstract

Background Several techniques have been described for esophagogastric anastomosis following esophagectomy. This study compared the outcomes of circular stapled anastomoses with semi-mechanical technique using a linear stapler. Methods Perioperative data were extracted from a contemporaneously collected database of all consecutive esophagectomies for cancer with intrathoracic anastomoses performed in the Trent Oesophago-Gastric Unit between January 2015 and April 2018. Anastomotic techniques: circular stapled versus semi-mechanical, were evaluated and outcomes were compared. The primary outcome was anastomotic leak rate. Secondary outcomes included anastomotic stricture, overall complication rates, length of stay (LOS) and 30 day all-cause mortality. Results One hundred and fifty-nine consecutive esophagectomies with intrathoracic anastomosis were performed during the study period. There were no significant differences between the two groups in terms of age, American Society of Anaesthesiologists score, Charlson comorbidity index and neoadjuvant therapies received. Circular stapled anastomoses were performed in 85 patients, while 74 patients received a semi-mechanical anastomosis. Clavien-Dindo complications II or more were higher in the circular stapled group (p = 0.02). There were 16 (10%) anastomotic leaks overall, three (4%) in semi-mechanical group versus 13 (15%) in the circular stapled group (p \ 0.019). There was no statistically significant difference between the two groups in terms of LOS, 30-day mortality or the need for endoscopic dilatation of the anastomosis at 3 months follow-up. Conclusion The move from a circular stapled to a semi-mechanical intrathoracic anastomosis has been associated with a reduced postoperative anastomotic leak rate following esophagectomy for esophageal cancer.

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

“…Furthermore, metanalyses for open esophagectomy have stated that the patients receiving LS anastomoses after esophagectomy tend to have fewer anastomotic strictures in comparison to the patients receiving CS anastomoses while having similar rates of anastomotic insufficiencies [ 22 , 23 ]. Yanni et al even displayed higher rates in anastomotic insufficiency in the patients receiving CS when compared to LS [ 24 ].…”

Transthoracic Esophagectomy: Hand-sewn Versus Side-to-side Linear-stapled Versus Circular-stapled Anastomosis: A Systematic Review and Meta-analysis

“…Another study compared intrathoracic SSLS (n = 74) with CS (n = 85) anastomosis, and found that employing a semimechanical side-to-side esophagogastric anastomosis significantly reduced the rate of leaks (4.1% vs. 15.3%, P = 0.019). 115 In our study comprising a larger number of patients undergoing esophagectomy with intrathoracic anastomosis we found that HS (OR = 1.73) and SSLS (OR = 1.68) anastomoses were associated with a significantly higher risk of anastomotic leak than CS anastomosis.…”

“…Blackmon et al15 performed a propensity-matched analysis of 3 techniques for intrathoracic esophagogastric anastomosis (23 patients in each group) and showed similar leak rates after SSLS (8.7%), CS (4.3%), and HS (4.3%) anastomosis ( P =0.78). Another study compared intrathoracic SSLS (n=74) with CS (n=85) anastomosis, and found that employing a semimechanical side-to-side esophagogastric anastomosis significantly reduced the rate of leaks (4.1% vs. 15.3%, P =0.019) 115. In our study comprising a larger number of patients undergoing esophagectomy with intrathoracic anastomosis we found that HS (OR=1.73) and SSLS (OR=1.68) anastomoses were associated with a significantly higher risk of anastomotic leak than CS anastomosis.…”

Video-Assisted Thoracic Surgery Intrathoracic Anastomosis Technique

“…The linear stapling technique is a side-to-side anastomosis between the esophagus and the conduit, which has been reported to be functionally favorable with a larger diameter of the anastomosis that offers easy passage of the intraluminal content and reduced circular pressure at the anastomosis site. These factors might explain the low incidence of anastomotic leakage and strictures [ 21 - 23 ].…”