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The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy

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Abstract

Background

Cervical anastomotic stricture after esophagectomy is a serious complication that adversely affects postoperative recovery, nutritional status and quality of life. Cervical anastomosis by a circular stapler (CS) has been widely accepted as a simple and convenient method, but anastomotic strictures are likely to occur. The aim of this study was to investigate an association between CS size and the incidence of anastomotic stricture after cervical esophagogastric anastomosis performed by a CS.

Methods

Between April 2011 and March 2016, 236 consecutive patients underwent cervical esophagogastric anastomosis by a CS via a retrosternal route after esophagectomy for esophageal cancer. These patients were divided into according to CS size for the procedure as follows: small-sized (25 mm) CS group (SG, n = 116) and large-sized (28 or 29 mm) CS group (LG, n = 120). The clinical data of patients were analyzed retrospectively to compare the two groups.

Results

Overall, anastomotic strictures were observed in 90 patients (38%). The incidence of anastomotic stricture was significantly lower in the LG than the SG (23% vs. 53%, p < 0.001) (Table 3). Chronic obstructive pulmonary disease (COPD: FEV1.0% <70%) (OR 2.35, 95% CI = 1.09–5.14; p = 0.029), anastomotic leakage (OR 8.97, 95% CI = 2.69–41.30; p < 0.001), and a small-sized CS (OR 3.42, 95% CI = 1.82–6.62; p < 0.001) were independent risk factors for anastomotic stricture in the multivariate analysis.

Conclusions

If possible, a large-sized CS should be used to prevent cervical anastomotic strictures when performing cervical anastomoses by CS.

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Acknowledgements

The authors would like to thank the members of Department of Gastroenterological Surgery at Aichi Cancer Center Hospital for useful comments and suggestions, and Keitaro Matsuo, MD, PhD, MSc (Division of Cancer Epidemiology and Prevention Aichi Cancer Center Research Institute) for his guidance on statistical analysis.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan

    Takahiro Hosoi, Tetsuya Abe, Norihisa Uemura, Eiji Higaki, Ryosuke Kawai, Jiro Kawakami, Byonggu An & Yasuhiro Shimizu

  2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Takahiro Hosoi, Tetsuya Abe, Norihisa Uemura, Eiji Higaki, Ryosuke Kawai, Jiro Kawakami, Masato Nagino & Yasuhiro Shimizu

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Hosoi, T., Abe, T., Uemura, N. et al. The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy. World J Surg 43, 1746–1755 (2019). https://doi.org/10.1007/s00268-019-04938-8

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