Abstract
BackgroundFor patients undergoing an Ivor Lewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown. The aim of this study was to compare the 25 mm stapled versus the 28 mm stapled esophagogastric anastomosis after Ivor Lewis esophagectomy, focusing on anastomotic insufficiency and postoperative anastomotic strictures. MethodsBetween February 2008 and June 2019, 349 consecutive patients underwent Ivor Lewis esophagectomy with gastric conduit reconstruction and circular stapled anastomosis. Patient characteristics and postoperative results, such as anastomotic insufficiency rates, postoperative anastomotic stricture rates, time to anastomotic stricture rate, and the number of dilatations, were recorded in a prospective database and analyzed. ResultsIn 222 patients (64%), the 25 mm circular stapler was used and in 127 patients (36%) the 28 mm circular stapler was used. There were no differences in baseline characteristics. Anastomotic insufficiency rates were comparable between the 25 mm (12%) and the 28 mm groups (11%) (p = 0.751). There were no differences between postoperative anastomotic strictures in the 25 mm (14%) and the 28 mm groups (14%) (p = 0.863). Within patients with postoperative anastomotic strictures, a median number of 2 dilatations were observed in each group (p = 0.573) without differences in the time to first diagnosis (p = 0.412). ConclusionThere were no differences in anastomotic insufficiency and postoperative anastomotic stricture rates between the 25 mm and the 28 mm circular stapled esophagogastric anastomosis after Ivor Lewis esophagectomy. Both the 25 mm and 28 mm stapler can be safely used to create a circular stapled esophagogastric anastomosis to restore continuity after esophagectomy.
Highlights
Background For patients undergoing an IvorLewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown
We present our experience with the 25 mm and 28 mm circular stapler devices for esophagogastric anastomosis after esophagectomy in a large volume tertiary referral center for esophageal cancer
There were no differences in baseline characteristics between the two groups and baseline characteristics were representative for patients with esophageal cancer in the Western world (Table 1)
Summary
Background For patients undergoing an IvorLewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown. Neoadjuvant treatment followed by esophagectomy with 2field lymphadenectomy is the golden standard in the surgical treatment of patients with esophageal cancer.[1,2,3] Compared to an open transthoracic esophagectomy (robot assisted), minimally invasive esophagectomy results in a lower percentage of postoperative complications.[4,5] After esophagectomy, continuity of the gastrointestinal tract is restored by creating a gastric conduit with an esophagogastric anastomosis It is currently unknown, if a McKeown procedure (cervical anastomosis) or an Ivor Lewis procedure (intrathoracic anastomosis) should be preferred for patients with
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