Application of different intrathoracic esophagogastric anastomosis in surgery for esophageal cancer

Abstract

Intrathoracic esophagogastric anastomosis is the mainstay of esophageal reconstruction after esophagectomy for the middle and lower esophageal cancer, which is the majority of esophageal cancer. In spite of the constant development of techniques and instruments for esophageal reconstruction, incidence of anastomotic complications stays high, including anastomotic leak and stricture. The current common esophagogastric anastomosis primarily consists of hand-sewn anastomosis and stapled anastomosis. This review presented different ways of intrathoracic esophagogastric anastomosis in reference to the literatures in China and abroad, and comparisons and analyses were made according to operative techniques, anastomotic complication rates, postoperative mortality rates, etc. The results demonstrated that various anastomotic methods had individual, advantages and disadvantages. Duration of stapled anastomosis is short, and linear-stapled anastomosis has a low incidence of anastomotic stricture. Traditional hand-sewn anastomosis, as a necessary skill for thoracic surgeons, shows great manipulative flexibility and reliability. Moreover, the advances in minimally invasive esophageal surgery, such as robot-assisted esophagectomy, increases the operability and efficiency of hand-sewn anastomosis with a promising perspective. In general, among diverse anastomotic methods, mortality does not differ, and the comparison of anastomotic leak rates requires further large clinical trials. Thoracic surgeons have to decide on the anastomotic method of every single case based on patient characteristics and technical proficiency, with the final aim of minimizing anastomotic complications and maximizing patient benefits.