Esophagectomy Anastomosis Research Articles

The Comparison of Hand-Sewn and Stapled Anastomosis in Esophagectomy

The Comparison of Hand-Sewn and Stapled Anastomosis in Esophagectomy

WITHDRAWN: Intrathoracic versus cervical anastomosis in esophagectomy for esophageal cancer: A meta-analysis of randomized controlled trials

<h2>Abstract</h2><h3>Background</h3> Intrathoracic anastomosis(IA) and cervical anastomosis(CA) has been used for the esophagectomy of esophageal cancer, we aimed to evaluate the effects and safety of IA versus CA in the esophagectomy. <h3>Methods</h3> We searched PubMed, EMBASE, The Cochrane Library, Web of Knowledge, China national knowledge infrastructure (CNKI) and WanFang databases up to Sept 30, 2021 for RCTs on CA versus IA for the treatment of esophageal cancer. <h3>Results</h3> 12 RCTs total of 1493 patients were finally included. hThe incidence of anastomotic leak[RR = 2.76, 95%CI (1.94–3.94), P < 0.001] and recurrent laryngeal nerve injury [RR = 6.12, 95%CI (3.02–12.41), P < 0.001] in the IA group were less than that of CA group. There were no significant difference in the incidence of anastomotic stenosis [RR = 1.33, 95%CI (0.88–2.00), P = 0.18], pneumonia [RR = 1.31, 95%CI (0.82–2.09), P = 0.25], postoperative chylothorax[RR = 1.01, 95%CI (0.40–2.52), P = 0.99] and mortality [RR = 0.93, 95%CI (0.52–1.68), P = 0.82] between two groups. <h3>Conclusions</h3> IA is a safer and more reliable method of gastrointestinal reconstruction for esophagectomy.

Intrathoracic versus cervical anastomosis in esophagectomy for esophageal cancer: A meta-analysis of randomized controlled trials

BackgroundIntrathoracic anastomosis and cervical anastomosis are very common in the esophagectomy of esophageal cancer; we aimed to evaluate the effects and safety of intrathoracic anastomosis versus cervical anastomosis in the esophagectomy. MethodsWe searched PubMed, EMBASE, Cochrane Library, Web of Knowledge, China National Knowledge Infrastructure, and WanFang databases up to September 30, 2021, for randomized controlled trials focused on cervical anastomosis versus intrathoracic anastomosis for the treatment of esophageal cancer. ResultsIn total, 12 randomized controlled trials involving 1,493 patients were finally included. The incidence of anastomotic leak [relative risk = 2.76, 95% confidence interval (1.94∼3.94), P < .001] and recurrent laryngeal nerve injury [relative risk = 6.12, 95% confidence interval (3.02∼12.41), P < .001] in the intrathoracic anastomosis group were less than that of the cervical anastomosis group. There were no significant differences in the incidence of anastomotic stenosis [relative risk = 1.33, 95% confidence interval (0.88∼2.00), P = .18], pneumonia [relative risk = 1.31, 95% confidence interval (0.82∼2.09), P = .25], postoperative chylothorax [relative risk = 1.01, 95% confidence interval (0.40∼2.52), P = .99], and mortality [relative risk = 0.93, 95% confidence interval (0.52∼1.68), P = .82] between the 2 groups. ConclusionIntrathoracic anastomosis is associated with significantly reduced risk of leak and recurrent laryngeal nerve injury compared with cervical anastomosis.

The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

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.

Totally Mechanical Collard Technique for Cervical Esophagogastric Anastomosis Reduces Stricture Formation Compared with Circular Stapled Anastomosis.

The optimal technique for cervical esophagogastric anastomosis in esophagectomy has not yet been established. Using circular stapled (CS) technique effectively reduces the incidence of anastomotic leakage and shortens the operating time; however, anastomotic stricture has been reported to be more common. The present study was performed to compare the clinical outcomes of the recently developed totally mechanical Collard (TMC) and CS anastomosis. We retrospectively reviewed consecutive esophageal cancer cases who are undergoing transthoracic extended esophagectomy with gastric conduit reconstruction using cervical CS or TMC anastomosis from December 2013 to December 2016. Propensity score matching and multivariate regression were used to adjust for differences in baseline characteristics. Among 313 patients, 93 underwent CS anastomosis and 220 underwent TMC anastomosis. Stricture formation occurred in 59 patients (18.8%), significantly more often with the CS than TMC anastomosis (30.1% vs. 14.1%, p = 0.001). No significant differences were observed in the refractory stricture rate (9.7% vs. 5.0%, p = 0.134) or the anastomotic leakage rate (11.8% vs. 10.9%, p = 0.845) between the two groups. The propensity score matching cohort study including 86 pairs of patients confirmed a significantly lower stricture formation rate with the TMC than CS technique (27.9% vs. 14.0%, p = 0.038). In the multivariable analysis, anastomotic leakage, the CS technique, and a body mass index of ≥25mg/m2 were independently associated with a risk of stricture formation. TMC technique contributed to a reduced rate of stricture formation compared with CS technique in cervical esophagogastric anastomosis.

Pre-embedded cervical circular stapled anastomosis in esophagectomy.

BackgroundMechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications.MethodsIn total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre‐embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer.ResultsThe results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205–300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8–14 days with an average of 10.3 days.ConclusionOur data revealed that pre‐embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma.Key points This new technique can significantly reduce the risk of anastomotic leakage.This study adds further details enabling a smooth pre‐embedded procedure to be performed.

The influence of anastomosis-induced gastric wall defects on the blood supply to the gastric tube

The influence of anastomosis-induced gastric wall defects on the blood supply to the gastric tube

RA05.03: THE INFLUENCE OF ANASTOMOSIS ON THE BLOOD SUPPLY OF STOMACH AND THE OPTIMIZATION OF WIDTH OF TUBULAR STOMACH IN END-TO-SIDE ESOPHAGEAL-GASTRIC ANASTOMOSIS

Abstract Background End-to-side esophageal-gastric anastomosis is the most commonly used method of anastomosis in esophagectomy. Narrow gastric tube, especially 3cm-wide one, is thought to improve the blood supply of stomach. But with the combine use of these two techniques, we found alimentary tract leakage became more common. The reason was obscure. Few have considered the influence of anastomosis-induced gastric wall defect on the blood supply of gastric tube (Figure 1). We carried out this research to prove this hypothesis and to find out method to resolve this problem. Methods Animal experiment and clinical cohort study have been carried out. Narrow gastric tube group (3cm wide) and baseball-bat-shaped gastric tube group (5cm in avascular area) were compared. In animal experiment, 3 pigs in each group. Impaired blood supply will slow down blood flow and cause metabolic acidosis. So blood gas analysis (with the blood collected in gastric wall distal or proximal to the anastomosis) and arteriography with methylene blue were performed. pH and BE(from blood gas analysis) and time required for methylene blue to reach the tip of gastric tube were used to evaluate the blood supply of these areas. In cohort study, 176 patients were enrolled with 24 in narrow gastric tube group and 152 in bat-like gastric tube group. The incidence of leakage was compared. Results In animal experiment, before anastomosis, no metabolic acidosis was found in both groups. But after anastomosis, methylene blue couldn’t reach the gastric wall distal to the anastomosis, and the blood gas analysis shows metabolic acidosis with the blood from the same area, only in narrow group, These indicated insufficient blood supply in this area. In the cohort study, the incidence of leakage was much higher in narrow group. Conclusion Anastomosis can influence the blood supply of the gastric tube distal to it. It's the reason of the increase of alimentary tract fistula incidence with the use of 3cm-wide narrow gastric tube. Widen the gastric avascular area is an effective way to prevent this. So for end-to-side anastomosis, 5cm-wide gastric tube is preferred, while narrower gastric tube is suitable for other mode of anastomosis which do not cause gastric wall defect Disclosure All authors have declared no conflicts of interest.

Burn After Bleeding: Treatment of Esophagectomy Anastomosis Bleeding With Endoscopic Radiofrequency Ablation

Burn After Bleeding: Treatment of Esophagectomy Anastomosis Bleeding With Endoscopic Radiofrequency Ablation