Comparison of outcomes following end-to-end hand-sewn and mechanical oesophagogastric anastomosis after oesophagectomy for carcinoma: a prospective randomized controlled trial.

Abstract

The effects of the use of the stapler or hand-sewn method in oesophagogastric anastomosis on postoperative morbidity, mortality and quality of life after oesophagectomy remain controversial. The purpose of his study was to compare clinical outcomes of hand-sewn and stapler techniques in oesophagogastric anastomosis after oesophagectomy for oesophageal carcinoma. We performed a prospective randomized controlled trial on 478 patients treated for oesophageal tumour between February 2009 and December 2011. Patients were randomly assigned to two treatment groups with 237 patients in the hand-sewn group and 241 patients in the circular stapler group (http://www.chictr.org: ChiCTR-TRC-13004428). The mean follow-up time was 18 months. The mean operating time of the stapled group and the hand-sewn group were 193 and 226 min, respectively (P < 0.001). Seventeen clinical and radiological leakages occurred in the hand-sewn group compared with 7 in the stapler group (P = 0.033). In the stapler group hospital mortality occurred in 10 patients (4.3%) and in the hand-sewn group in 9 patients (3.9%) (P = 0.837). Anastomotic strictures were noted in 31 patients from the stapler group (14.2%) and in 16 patients from the hand-sewn group (7.5%) (P = 0.027). Using the circular stapler method in oesophagogastric anastomoses had a lower anastomotic leakage rate and shorter operating time compared with the hand-sewn method. However, the circular stapler method was associated with a significantly increased risk of anastomotic strictures.