PS01.199: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL OF CIRCULAR STAPLING VERSUS TRIANGULATING STAPLING ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CANCER

Abstract Background Several studies have reported that the triangulating stapling method decreases the incidence of anastomotic stricture after esophagectomy, but no randomized, controlled trial has confirmed the efficacy of the triangulating stapling method for cervical esophagogastrostomy. We compared triangulating stapling and circular stapling for cervical esophagogastric anastomosis regarding the decrease in anastomotic stricture after esophagectomy for thoracic esophageal cancer. Methods Between August 2010 and April 2014, 100 patients enrolled in this randomized, controlled trial at the Wakayama Medical University Hospital were allocated randomly to either the circular stapling group (n = 49) or the triangulating stapling group (n = 51). The primary end point was the incidence of anastomotic stricture within 12 months postoperatively. This randomized, controlled trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN000004848). Results There were no differences between the circular stapling and triangulating stapling groups in terms of clinical data. The amount of time required for esophagogastric anastomosis was slightly greater for the triangulating stapling group (22 minutes) than for the circular stapling group (18 minutes) (P = .028). Anastomotic stricture occurred in 8 patients (17%) in the circular stapling group and 9 patients (19%) in the triangulating stapling group (P = .935). The rate of anastomotic leakage was 11% for the circular stapling group and 2% for the triangulating stapling group (P = .073). Conclusion This RCT compared 2 techniques of cervical esophagogastric anastomosis after esophagectomy for esophageal cancer. This study is the first to compare these 2 methods in a randomized, controlled fashion.This study could not show that the triangulating stapling method was superior to the circular stapling method for cervical esophagogastrostomy to reduce anastomotic stricture. The triangulating stapling method, however, might have the potential to decrease the rate of anastomotic leakage; a large-scale RCT will be required to assess this question. Disclosure All authors have declared no conflicts of interest.

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Triangulating stapling vs functional end-to-end stapling for cervical esophagogastric anastomosis after esophagectomy for thoracic esophageal cancer: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-019-3201-2 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Toshiaki Tsuji ◽

Toshiyasu Ojima ◽

Mikihito Nakamori ◽

Masaki Nakamura ◽

Masahiro Katsuda ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Esophageal Cancer ◽

Study Protocol ◽

Controlled Trial ◽

Esophagogastric Anastomosis ◽

Thoracic Esophageal Cancer ◽

Cancer Study ◽

Randomized Controlled ◽

Cervical Esophagogastric Anastomosis ◽

End To End

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Circular stapling versus triangulating stapling for the cervical esophagogastric anastomosis after esophagectomy in patients with thoracic esophageal cancer: A prospective, randomized, controlled trial

Surgery ◽

10.1016/j.surg.2017.01.013 ◽

2017 ◽

Vol 162 (1) ◽

pp. 131-138 ◽

Cited By ~ 17

Author(s):

Keiji Hayata ◽

Mikihito Nakamori ◽

Masaki Nakamura ◽

Toshiyasu Ojima ◽

Makoto Iwahashi ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Esophageal Cancer ◽

Controlled Trial ◽

Esophagogastric Anastomosis ◽

Thoracic Esophageal Cancer ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Cervical Esophagogastric Anastomosis

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Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

10.21203/rs.3.rs-17780/v3 ◽

2020 ◽

Author(s):

Seyed Ziaeddin Rasihashemi ◽

Ali Ramouz ◽

Samad Beheshtirouy ◽

Hassan Amini

Keyword(s):

Esophageal Cancer ◽

Anastomotic Leakage ◽

Anastomotic Stricture ◽

Anastomosis Group ◽

Transhiatal Esophagectomy ◽

Stapled Anastomosis ◽

Esophagogastric Anastomosis ◽

Thoracic Esophageal Cancer ◽

Cervical Esophagogastric Anastomosis

Abstract Background: Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients.Methods: This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in two weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation.Results: Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46±84.33 min and 250.55±43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02).Conclusion: Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

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Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

10.21203/rs.3.rs-17780/v2 ◽

2020 ◽

Author(s):

Seyed Ziaeddin Rasihashemi ◽

Ali Ramouz ◽

Samad Beheshtirouy ◽

Hassan Amini

Keyword(s):

Esophageal Cancer ◽

Anastomotic Leakage ◽

Anastomotic Stricture ◽

Anastomosis Group ◽

Transhiatal Esophagectomy ◽

Stapled Anastomosis ◽

Esophagogastric Anastomosis ◽

Thoracic Esophageal Cancer ◽

Cervical Esophagogastric Anastomosis

Abstract Background: Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients. Methods: This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in two weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation. Results: Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46±84.33 min and 250.55±43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02). Conclusion: Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

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Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

10.21203/rs.3.rs-17780/v4 ◽

2020 ◽

Author(s):

Seyed Ziaeddin Rasihashemi ◽

Ali Ramouz ◽

Samad Beheshtirouy ◽

Hassan Amini

Keyword(s):

Esophageal Cancer ◽

Anastomotic Leakage ◽

Anastomotic Stricture ◽

Anastomosis Group ◽

Transhiatal Esophagectomy ◽

Stapled Anastomosis ◽

Esophagogastric Anastomosis ◽

Thoracic Esophageal Cancer ◽

Cervical Esophagogastric Anastomosis

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Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2004.02.026 ◽

2004 ◽

Vol 25 (6) ◽

pp. 1097-1101 ◽

Cited By ~ 74

Author(s):

H HSU ◽

J CHEN ◽

P HUANG ◽

J LEE ◽

Y LEE

Keyword(s):

Squamous Cell Carcinoma ◽

Randomized Controlled Trial ◽

Cell Carcinoma ◽

Squamous Cell ◽

Controlled Trial ◽

Esophageal Resection ◽

Esophagogastric Anastomosis ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

Cervical Esophagogastric Anastomosis

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Stage 2 Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm10102182 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2182

Author(s):

Jihyun Kim ◽

Hoyoung Lee ◽

Tae-Young Choi ◽

Joong Il Kim ◽

Byoung-Kab Kang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Ovarian Response ◽

Controlled Ovarian Hyperstimulation ◽

University Hospital ◽

Ovarian Hyperstimulation ◽

Poor Ovarian Response ◽

Vitro Fertilization ◽

Randomized Controlled

Acupuncture is believed to improve ovarian reserve and reproductive outcomes in women undergoing in vitro fertilization (IVF). This study was conducted to evaluate the effect of network-optimized acupuncture followed by IVF on the oocyte yield in women showing a poor ovarian response. This study was an exploratory randomized controlled trial conducted from June 2017 to January 2020 at the Pusan National University Hospital. Women diagnosed with poor ovarian response were enrolled and randomly divided into two groups: IVF alone and Ac + IVF groups (16 acupuncture sessions before IVF treatment). Eight acupoints with high degree centrality and betweenness centrality were selected using network analysis. Among the participants, compared with the IVF treatment alone, the acupuncture + IVF treatment significantly increased the number of retrieved mature oocytes in women aged more than 37 years and in those undergoing more than one controlled ovarian hyperstimulation cycle. The negative correlation between the number of retrieved mature oocytes and consecutive controlled ovarian hyperstimulation cycles was not observed in the Ac + IVF group irrespective of the maternal age. These findings suggest that physicians can consider acupuncture for the treatment of women with poor ovarian response and aged > 37 years or undergoing multiple IVF cycles.

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