Stapled vs hand-sewn anastomosis in esophagectomy: leakage 6.7% vs 11.1% in 138 patients, retrospective

A single-center retrospective study published in BMC Cancer compared two ways of joining the esophagus and stomach after totally minimally invasive Ivor-Lewis esophagectomy for esophagogastric junction cancer. It included 138 patients: 75 had a posterior-to-greater curvature side-to-side linear stapled anastomosis (PG-LS), and 63 had an end-to-end hand-sewn anastomosis (HS) biomedcentral.comBMC Cancerbiomedcentral.comOpen source ↗.

The primary endpoints were anastomotic leakage and early anastomotic stenosis within 30 days. Neither differed significantly between groups.

Leakage and stenosis

Anastomotic leakage occurred in 6.7% of the PG-LS group and 11.1% of the HS group (risk difference −4.4%, 95% CI −14.0% to 5.2%; P = 0.381). Early 30-day stenosis was seen in 1.3% and 3.2% respectively (risk difference −1.8%, 95% CI −6.9% to 3.2%; P = 0.592).

After adjustment for age, sex, ECOG performance status and proximal margin, the odds ratio for leakage was 0.48 (95% CI 0.13–1.62; P = 0.236). Stenosis was not adjusted because of the very small number of events biomedcentral.comBMC Cancerbiomedcentral.comOpen source ↗.

Operative and postoperative differences

Intrathoracic operative time was 90.0 min in the PG-LS group versus 115.0 min in the HS group (P < 0.001). Intraoperative blood loss was 50.0 mL versus 100.0 mL (P < 0.001).

Inflammatory markers were also lower with stapling. Leukocytosis (WBC ≥ 10 × 10⁹/L) was found in 40.0% versus 61.9% of patients (P = 0.016), elevated procalcitonin (≥ 0.05 ng/mL) in 46.7% versus 66.7% (P = 0.025), and elevated IL-6 (≥ 7 pg/mL) in 41.3% versus 65.1% (P = 0.006).

Pulmonary infection occurred in 5.3% of the PG-LS group and 17.5% of the HS group (P = 0.029). Pleural effusion was recorded in 6.7% and 20.6% (P = 0.021) biomedcentral.comBMC Cancerbiomedcentral.comOpen source ↗.

Hospital stay, time to drain removal, ICU stay and gastrointestinal recovery time did not differ significantly. The authors state that PG-LS may be non-inferior to HS in postoperative recovery. They also note that the choice of technique should be individualized, taking into account patient preference, anatomy and surgeon experience.