Randomized Trial Comparing Side-to-Side Stapled and Hand-Sewn Esophagogastric Anastomosis in Neck

Abstract

BackgroundLeak from cervical esophagogastric anastomosis (CEGA) following esophagectomy is associated with morbidity and poor functional outcome. To address this issue, we conducted a randomized trial comparing “hand-sewn” with “stapled side-to-side” CEGA. MethodsOf 174 patients who underwent esophageal resection and CEGA between 2004 and 2010, 87 each were randomized to “hand-sewn” and “stapled side-to-side” CEGA [www.ClinicalTrials.gov: NCT00497549]. The primary outcome measure was anastomotic leak rate. The secondary outcome measures included CEGA construction time and occurrence of anastomotic stricture during follow up. ResultsThe overall anastomotic leak rate was 17.2 % (major leaks: 8 %). The leak rate was similar among the two groups (hand-sewn: 14/87, stapled: 16/87; p = 0.33). The stapled anastomotic technique was faster (25 ± 6.5 min vs. 27 ± 5.5 min; p = 0.02). The overall operative mortality and morbidity rates were 6.3 % and 40.8 %, respectively. At a median follow up of 12 (6–42) months, anastomotic stricture occurred in 24 (14.7 %) patients and was significantly more common in the “hand-sewn” group (17/82 vs. 7/81; p = 0.045). ConclusionThere were no differences in the leak rates and postoperative outcome between the two CEGA techniques. At follow up, anastomotic strictures occurred less frequently following stapled CEGA. The ideal CEGA technique remains elusive.