Does Circular Stapler Size in Surgical Management of Esophageal Cancer Affect Anastomotic Leak Rate? 4-Year Experience of a European High-Volume Center

Müller, Dolores T.; Babic, Benjamin; Herbst, Veronika; Gebauer, Florian; Schlößer, Hans; Schiffmann, Leif; Schröder, Wolfgang; Bruns, Christiane; Fuchs, Hans

doi:10.3390/cancers12113474

Cited by 20 publications

(19 citation statements)

References 18 publications

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“…The current results from leading esophagus surgery centers support the use of a circular stapler esophagogastrostomy, especially for minimally invasive intrathoracic anastomosis [5,22]. The stapler diameter should be selected according to the individual anatomical situation of the patient but with preference for the largest possible diameter; however, a significant difference regarding anastomotic leakage and stricture was not identified between 25-and 28-mm diameter sizes [29].…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial

Egberts

Welsch

Merboth

et al. 2022

Langenbecks Arch Surg

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Purpose Robotic-assisted minimally invasive esophagectomy (RAMIE) has become one standard approach for the operative treatment of esophageal tumors at specialized centers. Here, we report the results of a prospective multicenter registry for standardized RAMIE. Methods The German da Vinci Xi registry trial included all consecutive patients who underwent RAMIE at five tertiary university centers between Oct 17, 2017, and Jun 5, 2020. RAMIE was performed according to a standard technique using an intrathoracic circular stapled esophagogastrostomy. Results A total of 220 patients were included. The median age was 64 years. Total minimally invasive RAMIE was accomplished in 85.9%; hybrid resection with robotic-assisted thoracic approach was accomplished in an additional 11.4%. A circular stapler size of ≥28 mm was used in 84%, and the median blood loss and operative time were 200 (IQR: 80–400) ml and 425 (IQR: 335–527) min, respectively. The rate of anastomotic leakage was 13.2% (n=29), whereas the two centers with >70 cases each had rates of 7.0% and 12.0%. Pneumonia occurred in 19.5% of patients, and the 90-day mortality was 3.6%. Cumulative sum analysis of the operative time indicated the end of the learning curve after 22 cases. Conclusions High-quality multicenter registry data confirm that RAMIE is a safe procedure and can be reproduced with acceptable leak rates in a multicenter setting. The learning curve is comparably low for experienced robotic surgeons.

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Section: Discussionmentioning

confidence: 99%

Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial

Egberts

Welsch

Merboth

et al. 2022

Langenbecks Arch Surg

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“…For circular stapling, however, choice of stapler and anvil size does not seem to matter significantly and should be adapted to a patient’s individual needs [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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

Finze

Betzler

Hetjens

et al. 2022

Langenbecks Arch Surg

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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.

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“…Sowohl der postoperative als auch der gesamte Intensivaufenthalt war in der RAMIE-Gruppe im Median 2 Tage kürzer (p < 0,001); nur die Wiederaufnahmerate auf eine Intensivstation unterschied sich nicht signifikant (16,0 % vs. 26,7 %, p = 0,081). Die mediane Krankenhausverweildauer betrug nach RAMIE nur 14 Tage (IQR [12][13][14][15][16][17][18][19][20][21][22], verglichen mit 20 Tagen (IQR 14-37, p < 0,001) in der Kontrollgruppe.…”

Section: Morbidität Und Mortalitätunclassified

“…Außerdem scheint eine an die anatomischen Gegebenheiten angepasste Wahl des Zirkularstaplers mit größtmöglichem Durchmesser ebenfalls die AI-Rate weiter reduzieren zu können. So war in einer Analyse von 632 Patienten nach Ivor-Lewis-Ösophagektomie die AI-Rate in der Gruppe mit einem Diameter von 28 mm um ein Drittel niedriger verglichen mit 25 mm Durchmesser, jedoch nur mit einem statistischen Trend (p = 0,092; [15]).…”

Section: Diskussionunclassified

Strategiewechsel zur minimal-invasiven Ösophagektomie – Ergebnisse an einem zertifizierten Zentrum

et al. 2021

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Zusammenfassung Hintergrund Es gibt Hinweise, dass die roboterassistierte minimal-invasive Ösophagektomie (RAMIE) die Morbidität im Vergleich zur konventionellen Operationstechnik verringern kann. Ziel der Arbeit Es erfolgte eine Vergleichsanalyse eines Single-Center-Strategiewechsels des Standards von offener Ösophagektomie zu RAMIE mit perioperativer, enteraler, selektiver Darmdekontamination (SDD). Material und Methoden Patienten- und Morbiditätsdaten nach elektiver RAMIE entsprechend dem neuen Standardmanagement zwischen Juli 2018 und September 2020 wurden retrospektiv mit einer historischen Kontrollkohorte nach offener Ösophagektomie zwischen Januar 2014 und Juni 2018 verglichen. Es erfolgte eine 1:1-Propensity-Score-Matching(PSM)-Analyse. Ergebnisse Insgesamt 75 Patienten konnten nach PSM in beiden Gruppen analysiert werden. Etwa zwei Drittel der Operationen erfolgte aufgrund eines Adenokarzinoms und ein Drittel bei Plattenepithelkarzinom. Im Median wurden 22 bzw. 21 Lymphknoten reseziert. Die intrathorakale Ösophagogastrostomie erfolgte in der RAMIE-Gruppe in 97 % mit einem Zirkularstapler mit ≥28 mm Durchmesser (offen: 25 mm in 90 % der Fälle). Die Operationszeit war länger (Median 490 vs. 339 min, p < 0,001), hingegen waren der Blutverlust (Median 300 vs. 500 ml, p < 0,001), die Anastomoseninsuffizienz- (8,0 % vs. 25,3 %, p = 0,004), Wundinfektions- (4,0 % vs. 17,3 %, p = 0,008) und pulmonale Komplikationsrate (29,3 % vs. 44,0 %, p = 0,045) sowie die mediane Krankenhausverweildauer (14 vs. 20 Tage, p < 0,001) und die 90-Tage-Mortalität signifikant geringer verglichen mit der offenen Kontrollkohorte (4,0 % vs. 13,3 %, p = 0,039). Diskussion Ein konsequenter Wechsel des perioperativen Managements u. a. mit RAMIE und SDD kann zu einer stabilen Reduktion der Morbidität ohne Einschränkungen der onkologischen Radikalität führen.

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Does Circular Stapler Size in Surgical Management of Esophageal Cancer Affect Anastomotic Leak Rate? 4-Year Experience of a European High-Volume Center

Cited by 20 publications

References 18 publications

Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial

Robotic-assisted minimally invasive Ivor Lewis esophagectomy within the prospective multicenter German da Vinci Xi registry trial

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

Strategiewechsel zur minimal-invasiven Ösophagektomie – Ergebnisse an einem zertifizierten Zentrum

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