357 HAND-SEWN VERSUS STAPLED CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CARCINOMA: STUDY OF CLINICAL OUTCOMES FROM A HIGH VOLUME CENTER OF INDIA

Abstract

Abstract Esophageal cancer is a dreaded disease because of its adverse effects on swallowing and therefore the quality of life. Surgical resection offers the best outcome. The mainstay of any esophageal surgery is a well healed anastomosis without any leakage or stricture. Various techniques of anastomosis have been described. Hand sewn suture have been used since long. Surgical staplers have been recently introduced. We hereby describe a comparative study between these two surgical techniques. Methods Patients undergoing total esophagectomy with neck anastomosis between January 2013 and March 2019 were analysed. Esophagectomy was done by either trans-thoracic or trans-hiatal approach. The stomach was utilized as conduit and anastomosis was done in the neck in all patients. The gastric conduit was pulled into the neck by the posterior mediastinal route. End to side hand sewn anastomosis (HA) was done in 85 patients using 3-0 non absorbable sutures as a single full thickness layer. Side to side stapler anastomosis (SA) was done by posterior vertical and anterior horizontal firing of 45 mm blue linear stapler in 61 patients. Results The primary outcome measure was anastomotic leak. The secondary outcome measures included operative time, anastomosis time, blood loss, anastomotic stricture, mean intensive care unit(ICU) stay, ambulation, removal of intercostal drains, starting of feeding jejunostomy and oral feeds, mean hospital stay. Statistical analysis was done using SPSS. There was 9 cases anastomotic leak in the HA group while in the SA group there were none. Anastomotis stricture occurred in 12 patients in HA group while 3 werein the SA group and it’s statistically significant. The anastomotic time, ICU stay, time of starting oral feeds and mean hospital stay were statistically significant. Conclusion A well-healed anastomosis is the mainstay of the successful outcome of esophagectomy. Anastomotic leaks and strictures were the main complications of esophageal surgery. Various techniques of anastomosis have been described over the years. HA has been the standard of care since the inception of esophageal surgery. As technology developed SA got introduced and was found to have certain advantages over HA as shown in our study. SA may be used as preferred technique for esophago-gastrostomy.