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Totally Mechanical Collard Technique for Cervical Esophagogastric Anastomosis Reduces Stricture Formation Compared with Circular Stapled Anastomosis

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Abstract

Background

The optimal technique for cervical esophagogastric anastomosis in esophagectomy has not yet been established. Using circular stapled (CS) technique effectively reduces the incidence of anastomotic leakage and shortens the operating time; however, anastomotic stricture has been reported to be more common. The present study was performed to compare the clinical outcomes of the recently developed totally mechanical Collard (TMC) and CS anastomosis.

Methods

We retrospectively reviewed consecutive esophageal cancer cases who are undergoing transthoracic extended esophagectomy with gastric conduit reconstruction using cervical CS or TMC anastomosis from December 2013 to December 2016. Propensity score matching and multivariate regression were used to adjust for differences in baseline characteristics.

Results

Among 313 patients, 93 underwent CS anastomosis and 220 underwent TMC anastomosis. Stricture formation occurred in 59 patients (18.8%), significantly more often with the CS than TMC anastomosis (30.1% vs. 14.1%, p = 0.001). No significant differences were observed in the refractory stricture rate (9.7% vs. 5.0%, p = 0.134) or the anastomotic leakage rate (11.8% vs. 10.9%, p = 0.845) between the two groups. The propensity score matching cohort study including 86 pairs of patients confirmed a significantly lower stricture formation rate with the TMC than CS technique (27.9% vs. 14.0%, p = 0.038). In the multivariable analysis, anastomotic leakage, the CS technique, and a body mass index of ≥25 mg/m2 were independently associated with a risk of stricture formation.

Conclusion

TMC technique contributed to a reduced rate of stricture formation compared with CS technique in cervical esophagogastric anastomosis.

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Acknowledgement

The authors are grateful to Angela Morben from Edanz Group (Japan) for editing our manuscript.

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Authors and Affiliations

  1. Division of Esophageal Surgery, National Cancer Center Hospital East, Chiba, Japan

    Yuki Hirano, Takeo Fujita, Kazuma Sato, Takuji Sato, Hisashi Fujiwara & Hiroyuki Daiko

  2. Division of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yuki Hirano, Daisuke Kurita, Koshiro Ishiyama, Junya Oguma & Hiroyuki Daiko

  3. Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan

    Yuki Hirano

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  1. Yuki Hirano
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  2. Takeo Fujita
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  3. Kazuma Sato
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  4. Daisuke Kurita
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Correspondence to Hiroyuki Daiko.

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Hirano, Y., Fujita, T., Sato, K. et al. Totally Mechanical Collard Technique for Cervical Esophagogastric Anastomosis Reduces Stricture Formation Compared with Circular Stapled Anastomosis. World J Surg 44, 4175–4183 (2020). https://doi.org/10.1007/s00268-020-05729-2

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  • DOI: https://doi.org/10.1007/s00268-020-05729-2

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