| 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 2 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. |