Abstract
Purpose
Using a circular stapler to create an anastomosis for esophagogastrostomy after esophagectomy is well accepted; however, it remains uncertain if the greater curvature (GC) or lesser curvature (LC) of the gastric conduit is better for the anastomosis. We conducted this prospective study to compare the integrity of esophagogastrostomy between the esophagus and the GC or LC side of the gastric conduit.
Methods
The subjects of this study were 70 patients who underwent esophagectomy and were randomized to a “GC” group and an “LC” group (n = 35 each). The primary and secondary end points were anastomotic leakage (AL) and anastomotic stricture (AS), respectively.
Results
The overall AL rate was 22.1%, without a significant difference between the groups. Stump leakage developed in eight of nine patients in the GC group, whereas leakage developed at the esophagogastric anastomosis in five of six patients in the LC group. The rate of stump leakage was significantly higher than that of esophagogastric AL in the GC group. The overall AS rate was 4.4%, with a significant difference between the groups (0% in the GC group vs. 9.1% in the LC group).
Conclusions
AL rates were comparable in the two groups, but the sites of leakage were significantly different.
Similar content being viewed by others
References
Kamarajah SK, Lin A, Tharmaraja T, Bharwada Y, Bundred JR, Nepogodiev D, et al. Risk factors and outcomes associated with anastomotic leaks following esophagectomy: a systematic review and meta-analysis. Dis Esophagus. 2020;33:3.
Sobin LH, Gospodarowicz MK, Wittekind C (2011) TNM classification of malignant tumours. John Wiley and Sons.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68–74.
Hara H, Tahara M, Daiko H, Kato K, Igaki H, Kadowaki S, et al. Phase II feasibility study of preoperative chemotherapy with docetaxel, cisplatin, and fluorouracil for esophageal squamous cell carcinoma. Cancer Sci. 2013;104(11):1455–60.
Natsugoe S, Okumura H, Matsumoto M, Uchikado Y, Setoyama T, Yokomakura N, et al. Randomized controlled study on preoperative chemoradiotherapy followed by surgery versus surgery alone for esophageal squamous cell cancer in a single institution. Dis Esophagus. 2006;19(6):468–72.
Sasaki K, Uchikado Y, Omoto I, Arigami T, Osako Y, Noda M, et al. Neoadjuvant chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) for locally advanced esophageal squamous cell carcinoma. Cancer Chemother Pharmacol. 2019;83(3):581–7.
van Hagen P, Hulshof MC, Van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, for the CROSS Group, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–84.
Akiyama H, Miyazono H, Tsurumaru M, Hashimoto C, Kawamura T. Use of the stomach as an esophageal substitute. Ann Surg. 1978;188(5):606–10.
Klijn E, Niehof S, De Jonge J, Gommers D, Ince C, Van Bommel J. The effect of perfusion pressure on gastric tissue blood flow in an experimental gastric tube model. Anesth Analg. 2010;110(2):541–6.
Liebermann-Meffert DM, Meier R, Siewert JR. Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg. 1992;54(6):1110–5.
Murakami M, Sugiyama A, Ikegami T, Ishida K, Maruta F, Shimizu F, et al. Revascularization using the short gastric vessels of the gastric tube after subtotal esophagectomy for intrathoracic esophageal carcinoma. J Am Coll Surg. 2000;190(1):71–7.
Sekido M, Yamamoto Y, Minakawa H, Sasaki S, Furukawa H, Sugihara T, et al. Use of the “supercharge” technique in esophageal and pharyngeal reconstruction to augment microvascular blood flow. Surgery. 2003;134(3):420–4.
Nederlof N, Tilanus HW, Tran TC, Hop WC, Wijnhoven BP, de Jonge J. End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg. 2011;254(2):226–33.
Hayata K, Nakamori M, Nakamura M, Ojima T, Iwahashi M, et al. Circular stapling versus triangulating stapling for the cervical esophagogastric anastomosis after esophagectomy in patients with thoracic esophageal cancer: a prospective, randomized, controlled trial. Surgery. 2017;162(1):131–8.
Roumen RM, Rahusen FTG, Wijnen MH, Croiset van Uchelen FAC. “Dog ear” formation after double-stapled low anterior resection as a risk factor for anastomotic disruption. Dis Colon Rectum. 2000;43(4):522–5.
Ladak F, Dang JT, Switzer N, Mocanu V, Tian C, Birch D, et al. Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis. Surg Endosc. 2019;33(2):384–94.
Goense L, van Rossum PS, Ruurda JP, van Vulpen M, Mook S, Meijer GJ, et al. Radiation to the gastric fundus increases the risk of anastomotic leakage after esophagectomy. Ann Thorac Surg. 2016;102:1798–804.
Funding
There is no funding to report.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest associated with this article to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sasaki, K., Omoto, I., Uchikado, Y. et al. Comparison of greater curvature and lesser curvature circular-stapled esophagogastrostomy after esophagectomy in patients with esophageal cancer: a prospective randomized controlled trial. Surg Today 51, 575–581 (2021). https://doi.org/10.1007/s00595-020-02147-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-020-02147-8