Modified Collardversusend‐to‐side hand‐sewn anastomosis for cervical anastomosis afterMcKeownesophagectomy

Abstract

Background: According to previously published studies, esophagectomy with modified Collard anastomosis has been reported to have low incidences of anastomotic leak and stricture. However, the optional anastomotic method after esophagectomy is still controversial. We conducted this study to compare the incidence of postoperative anastomotic stricture formation and dysphagia over three years after an esophagectomy with modified Collard anastomosis (MC) or end-to-side (ETS) hand-sewn anastomosis. Meanwhile, the early postoperative anastomotic leakage and other complications, hospital stay and 30-and 90-day mortality were also evaluated. Methods: The clinical data of 905 patients undergoing McKeown esophagectomy were retrospectively reviewed. The rate of postoperative stricture formation after three years was demonstrated by stricture-free survival which is the primary end-point of this study. The incidence of dysphagia, first time of onset of stricture and number of dilatations were also recorded during follow-up. Results: The incidence of anastomotic leak tended to be higher in the MC group compared with that in the ETS group (13.0% vs. 8.7%, P = 0.064). The rates of anastomotic stricture in the MC group were significantly less than in the ETS group (P = 0.004). The number of dilatations in the MC group were significantly greater than those in the ETS group (2.34 vs. 2.46, P = 0.011). Conclusions: A modified Collard cervical esophagogastric anastomosis was associated with lower rates of anastomotic stricture and dysphagia, compared with ETS hand-sewn anastomosis. However, the modified Collard anastomosis is accompanied by an increased anastomotic leakage rate.

Thoracolaparoscopic esophagectomy for esophageal cancer with a cervical or abdominal incision to extract specimen

“…Great tension and bad blood supply to the gastric conduit tip may lead to a high incidence of anastomotic leakage, resulting in a death risk three times as high as that without leakage and a mortality rate up to 60%. [ 2 ] In cervical anastomosis, the gastro-esophageal anastomosis can be performed outside the thorax. In our study, the anastomosis was performed by hand sewing before being pushed back into the thorax.…”

“…[30] Anastomotic complications are the major concern after esophagectomy, including anastomotic leakage and stenosis. [2,3,[10][11][12] In some patients, the overall survival may be closely related to successful anastomosis, avoidance of anastomotic tension, and maintenance of blood supply to the tip of gastric conduit. Great tension and bad blood supply to the gastric conduit tip may lead to a high incidence of anastomotic leakage, resulting in a death risk three times as high as that without leakage and a mortality rate up to 60%.…”

“…Esophageal cancer is one of the most common malignant tumors, ranking the sixth cause of cancer-related death in the world. [1][2][3] For resectable esophageal cancer, radical esophagectomy with complete lymphadenectomy is the preferred treatment option, however, despite advances in surgical technique and postoperative management, the prognosis of patients with esophageal cancer is poor, with the five-year overall survival rate ranging between 15% and 34%. [4] Moreover, the incidence of postoperative complications has been reported ranging 45% to 80%.…”