Cervical esophagogastric anastomosis using a modified linear cutter stapler technique in esophageal cancers following neoadjuvant chemoradiation

Background: Minimally invasive esophagectomy (MIE) has become a good option in the surgical treatment of esophageal cancer. Cervical esophagogastric anastomoses (CEGA) are widely used during esophagectomy. However, CEGA are related with a higher incidence of anastomotic complications. In the present study, a new procedure of T-shaped linear-stapled cervical esophagogastric anastomosis was used during MIE and the short-term outcomes are presented. Methods: From May 2014 to December 2018, 32 consecutive patients with esophageal cancer who underwent total MIE followed by T-shaped linear-stapled cervical esophagogastric anastomosis were included. Postoperative outcomes were analyzed. Results: Fifteen men and 17 women were included this pilot study. The histology of all cases was squamous cell carcinoma. Mean operation time of T-shaped linear-stapled cervical esophagogastric anastomosis was 17.6 minutes. There were no early or late mortalities. A minor cervical anastomotic leakage occurred in 1 patient. No complications of anastomotic stenosis occurred in this study. Conclusion: The T-shaped linear-stapled cervical esophagogastric anastomosis is efficient, reliable, easy to perform, and associated with lower postoperative complication rate.

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Use of the circular stapler for the cervical esophagogastric anastomosis in retrosternal gastric esophagoplasty

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)36709-1 ◽

1991 ◽

Vol 101 (4) ◽

pp. 745-746 ◽

Cited By ~ 2

Author(s):

E. Sarfati ◽

D. Gossot ◽

M. Celerier

Keyword(s):

Circular Stapler ◽

Esophagogastric Anastomosis ◽

Cervical Esophagogastric Anastomosis

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Transthoracic anastomotic leak after esophagectomy: Still a catastrophe?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.126 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 126-126

Author(s):

Martin McCarter ◽

Carrie Ryan ◽

Robert Meguid ◽

Alessandro Paniccia

Keyword(s):

Anastomotic Leak ◽

Transhiatal Esophagectomy ◽

Leak Rate ◽

Esophagogastric Anastomosis ◽

Nominal Data ◽

Cervical Anastomosis ◽

Randomized Controlled ◽

Significant Difference ◽

Cervical Esophagogastric Anastomosis ◽

Meta Analyses

126 Background: Leaks from intrathoracic esophagogastric anastomosis are thought to be associated with higher rates of morbidity and mortality than leaks from cervical anastomosis. We challenge this assumption, and hypothesize that there is no significant difference in mortality based on the position of the esophagogastric anastomosis. Methods: A systematic literature search was conducted using PubMed and Embase databases on all studies published between January 2000 and June 2015 comparing transthoracic (TTE) and transhiatal (THE) esophagectomies. Studies that used alternate reconstruction approaches were excluded. Outcomes analyzed were leak rate, leak-associated mortality, overall 30-day mortality, and overall morbidity. Meta-analyses were performed using Mantel Haenszel statistical analyses on studies that reported on leak rates of both approaches. Nominal data are presented as frequency and interquartile range (IQR); measures of the association between treatments and outcomes are presented as odds ratio (OR) with 95% confidence interval (CI). Results: Twenty-one studies (including 3 randomized controlled trials) were included comprising of 7167 patients (54% TTE). THE approach yields a higher anastomotic leak rate (12%; IQR: 11.6% - 22.1%) than TTE (9.8%; IQR: 6.0% - 12.2%) (OR: 1.83 [0.34-06.92]), without any difference in leak-associated mortality (7.1% TTE vs. 4.6% THE; OR: 1.83, [0.39-8.52]). There was no difference in overall 30-day mortality (3.9% TTE vs. 4.3% THE; OR: 0.86, [0.66-1.13]) and morbidity (59.0% TTE vs. 66.6% THE; OR: 0.76, [0.37-1.59]). Conclusions: Transthoracic esophagectomy is associated with a lower leak rate and does not result in higher morbidity or mortality than transhiatal esophagectomy. The previously assumed higher rate of transthoracic leak-associated mortality is overstated, thus allowing surgeon discretion and other factors to influence the choice of intrathoracic versus cervical esophagogastric anastomosis.

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