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End-to-side circular stapled versus side-to-side linear stapled intrathoracic esophagogastric anastomosis following minimally invasive Ivor–Lewis esophagectomy: comparison of short-term outcomes

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Abstract

Purpose

The search for the optimal procedure for creation of a safe gastroesophageal intrathoracic anastomosis with a lower risk of leakage in totally minimally invasive Ivor–Lewis esophagectomy (TMIIL) is ongoing. In the present study, we compared the outcomes of end-to-side (with circular stapler [CS]) and side-to-side (with linear stapler [LS]) techniques for intrathoracic anastomosis during TMIIL performed in 2 European high-volume centers for upper gastrointestinal surgery. A propensity score method was used to compare the CS and LS groups.

Methods

We retrospectively evaluated patients with lower esophageal cancer or Siewert type 1 or 2 esophagogastric junction carcinoma who underwent a planned TMIIL esophagectomy, performed from January 2017 to September 2020. The anastomosis was created by a semi-mechanical technique using a LS in one center and by a mechanical technique using a CS in the other center. General features, operative techniques, pathology data, and short-term outcomes were analyzed. Statistical evaluations were performed on the whole cohort, stratifying the analyses by risk strata factors identified with the propensity scores, and on a subgroup of patients matched by propensity score. The primary endpoint of the study was the rate of anastomotic leakage in the two groups. Secondary endpoints included rates of anastomotic stricture and overall postoperative complications.

Results

Considering the whole population, 256 patients were included; of those, 220 received the anastomosis with a circular stapler (CS group), and 36 received the anastomosis with a linear stapler (LS group). No significant differences by group in terms of sex, age, American Society of Anesthesiologists physical status classification, and type of neoplasm were showed. The rate of anastomotic leakage did not differ in the two groups (9.6% CS vs. 5.6% LS, p = 0.438), as well as the rate of anastomotic stricture in the 3-month follow-up (0.9% CS vs. 2.8% LS, p = 0.367). The rate of chyle leakage and of pulmonary, cardiac, and infective complications was not significantly different in the groups. After propensity score matching, 72 patients were included in the analysis. The 2 obtained propensity score matched groups did not differ for any of the clinical and pathologic variables considered for the analysis, resulting in well-balanced cohorts. The results obtained on the whole population were confirmed in the matched groups.

Conclusions

The results of our study suggest that both techniques for esophagogastric anastomosis during TMIIL are feasible, safe, and effective, with comparable rates of postoperative anastomotic leakage and stricture.

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Data availability

The datasets generated during the study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Digestive Surgery, European Institute of Oncology (IRCCS), Milan, Italy

    Manrica Fabbi, Uberto Fumagalli Romario & Stefano De Pascale

  2. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands

    Mark I. van Berge Henegouwen, Minke Feenstra & Suzanne S. Gisbertz

  3. Department of Experimental Oncology, European Institute of Oncology (IRCCS), Milan, Italy

    Sara Gandini

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  1. Manrica Fabbi
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Contributions

All the authors listed above contributed substantially to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work; and all the authors contributed to the drafting of the work or revising it critically for important intellectual content and the final approval of the version to be published; and all the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Manrica Fabbi.

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Fabbi, M., van Berge Henegouwen, M.I., Fumagalli Romario, U. et al. End-to-side circular stapled versus side-to-side linear stapled intrathoracic esophagogastric anastomosis following minimally invasive Ivor–Lewis esophagectomy: comparison of short-term outcomes. Langenbecks Arch Surg 407, 2681–2692 (2022). https://doi.org/10.1007/s00423-022-02567-9

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