Skip to main content
SpringerLink
Log in

Esophagogastrectomy: The influence of stapled versus hand-sewn anastomosis on outcome

  • Published:
Journal of Gastrointestinal Surgery Aims and scope

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Successful anastomosis is essential for favorable esophagogastrectomy outcomes. Before July 2002, almost all esophagogastric anastomoses at our institution were hand-sewn. We then began using linear stapled anastomotic techniques. This review compares patient outcomes with both techniques. From July 2001 to June 2004, 280 consecutive esophagogastrectomy patients (235 men and 45 women) were reviewed (median age, 65 years). The anastomosis was intrathoracic in 206 patients (74%) and cervical in 74 (26%). Anastomoses were hand-sewn in 205 patients (73%) and linear stapled in 75 (27%). Stapled anastomoses were intrathoracic in 33 patients (16%) and cervical in 42 (57%). Anastomotic leaks occurred in 30 patients (11%); 26 (12.7%) in the hand-sewn and 4 (5.3%) in the linear stapled group (P = .008). Leaks were asymptomatic in 17 patients (57%). Dilatation was required in 70 hand-sewn anastomoses (34%) and in 11 stapled (14.6%) (P = .001). Hand-sewn anastomoses were more likely to leak and require dilatation; odds ratios and 95% confidence intervals were 5.35 (1.67–19.27) and 3.58 (1.66–8.34), respectively. A linear stapled anastomosis is safe and associated with both a significantly lower leak rate and the need for dilatation compared with hand-sewn anastomosis. This nonrandomized series suggests that linear stapled anastomosis is the preferred technique regardless of anastomotic location.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. King RM, Pairolero PC, Trastek VF, Payne WS, Bernatz PE. Ivor Lewis esophagogastrectomy for carcinoma of the esophagus: early and late functional results. Ann Thorac Surg 1987;44:119–122.

    Article  PubMed  CAS  Google Scholar 

  2. Visbal AL, Allen MS, Miller DL, Deschamps C, Trastek VF, Pairolero PC. Ivor Lewis esophagogastrectomy for esophageal cancer. Ann Thorac Surg 2001;71:1803–1808.

    Article  PubMed  CAS  Google Scholar 

  3. Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 1999;230:392–403.

    Article  PubMed  CAS  Google Scholar 

  4. Orringer MB. Transthoracic versus transhiatal esophagectomy: what difference does it make (editorial)? Ann Thorac Surg 1987;44:116–118.

    Article  PubMed  CAS  Google Scholar 

  5. Fok M, Ah-Chong AK, Cheng SWK, Wong J. Comparison of a single layer continuous hand-sewn method and circular stapling in 580 oesophageal anastomoses. Br J Surg 1991; 78:342–345.

    Article  PubMed  CAS  Google Scholar 

  6. Urschel JD, Blewett CJ, Bennett WF, Miller JD, Young JEM. Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esophagus 2001;14:212–217.

    Article  PubMed  CAS  Google Scholar 

  7. Valverde A, Hay JM, Fingerhut A, Elhadad A. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. Surgery 1996;120:476–483.

    Article  PubMed  CAS  Google Scholar 

  8. McLarty AJ, Deschamps C, Trastek VF, Allen MS, Pairolero PC, Harmsen MS. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 1997;63:1568–1572.

    Article  PubMed  CAS  Google Scholar 

  9. Young MM, Deschamps C, Trastek VF, et al. Esophageal reconstruction for benign disease: early morbidity, mortality, and functional results. Ann Thorac Surg 2000;70:1651–1655.

    Article  PubMed  CAS  Google Scholar 

  10. Iannettoni MD, Whyte RI, Orringer MB. Catastrophic complications of the cervical esophagogastric anastomosis. J Thorac Cardiovasc Surg 1995;110:1493–1501.

    Article  PubMed  CAS  Google Scholar 

  11. Linden PA, Swanson SJ. Esophageal resection and replacement. In: Sellke FW, ed. Sabiston and Spencer’s Surgery of the Chest, vol. 1, 7th ed. Philadelphia: Elsevier, 2005, pp 627–651.

    Google Scholar 

  12. Port JL, Korst R, Altorki NK. Transthoracic resection of the esophagus. In: Shields TW, ed. General Thoracic Surgery, vol. 2, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2005, pp 1987–2003.

    Google Scholar 

  13. Cassivi SD. Leaks, strictures and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg 2004;16:124–132.

    Article  PubMed  Google Scholar 

  14. Headrick JR, Nichols FC, Miller DL, et al. High-grade esophageal dysplasia: long-term survival and quality of life after esophagectomy. Ann Thorac Surg 2002;73:1697–1703.

    Article  PubMed  Google Scholar 

  15. Fleming ID, Cooper JS, Henson DE, et al, eds. American Joint Committee on Cancer. Manual for Staging of Cancer. 5th ed. Philadelphia: Lippincott-Raven, 1998.

    Google Scholar 

  16. Vigneswaran WT, Trastek VF, Pairolero PC, Deschamps C, Daly RC, Allen MS. Extended esophagectomy in the management of carcinoma of the upper thoracic esophagus. J Thorac Cardiovasc Surg 1994;107:901–907.

    PubMed  CAS  Google Scholar 

  17. McKeown KC. The surgical treatment of carcinoma of the oesphagus: a review of the results in 478 cases. J R Coll Surg Edinb 1985;30:1–14.

    PubMed  CAS  Google Scholar 

  18. Trastek VF. Esophagectomy: Ivor Lewis. In: Donohue JH, ed. Atlas of Surgical Oncology. Cambridge: Blackwell Science, 1995, pp 126–130.

    Google Scholar 

  19. Allen MS. Ivor Lewis esophagogastrectomy. Semin Thorac Cardiovasc Surg 1992;4:320–323.

    PubMed  CAS  Google Scholar 

  20. Jaroszewski DE, Deschamps C, Gunderson LL, Lanza LA, Trastek VF, Pairolero PC. Cancer of the esophagus. In: Kelly K, ed. Mayo Clinic Gastrointestinal Surgery. Philadelphia: WB Saunders, 2004, pp 57–73.

    Google Scholar 

  21. Vigneswaran WT, Trastek VF, Pairolero PC, Deschamps C, Daly RC, Allen MS. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg 1993;56:838–846.

    Article  PubMed  CAS  Google Scholar 

  22. Collard JM, Romagnoli R, Goncette L, Otte JB, Kestens PJ. Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy. Ann Thorac Surg 1998; 65:814–817.

    Article  PubMed  CAS  Google Scholar 

  23. Crestanello J, Deschamps C, Cassivi SC, et al. Selective management of intrathoracic anastomotic leak after esophagectomy. J Thorac Cardiovasc Surg 2005;129:254–260.

    Article  PubMed  Google Scholar 

  24. Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H. Surgical therapy of esophageal carcinoma. Br J Surg 1990;77:845–857.

    Article  PubMed  CAS  Google Scholar 

  25. Orringer MB, Marshall MB, Iannettoni MD. Eliminating the cervical esophagogastric anastomotic leak with a sidetoside stapled anastomosis. J Thorac Cardiovasc Surg 2000;119:277–288.

    Article  PubMed  CAS  Google Scholar 

  26. Briel JW, Tamhankar AP, Hagen JA, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 2004;198:536–542.

    Article  PubMed  Google Scholar 

  27. Santos R, Raftopoulos Y, Singh D, et al. Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques. Surgery 2004;136:917–925.

    Article  PubMed  Google Scholar 

  28. Law S, Fok M, Chu KM, Wong J. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 1997;226:169–173.

    Article  PubMed  CAS  Google Scholar 

  29. Ercan S, Rice TW, Murthy SC, Rybicki LA, Blackstone EH. Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg 2005;129:623–631.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Thoracic Surgery, Mayo Clinic College of Medicine, 200 First Street S.W., 55905, Rochester, MN

    Abdollah Behzadi M.D., Francis C. Nichols M.D., Stephen D. Cassivi M.D., Claude Deschamps M.D., Mark S. Allen M.D. & Peter C. Pairolero M.D.

Authors
  1. Abdollah Behzadi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francis C. Nichols M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen D. Cassivi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claude Deschamps M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark S. Allen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter C. Pairolero M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francis C. Nichols M.D..

Additional information

Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Behzadi, A., Nichols, F.C., Cassivi, S.D. et al. Esophagogastrectomy: The influence of stapled versus hand-sewn anastomosis on outcome. J Gastrointest Surg 9, 1031–1042 (2005). https://doi.org/10.1016/j.gassur.2005.06.025

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.gassur.2005.06.025

Key words

Search

Navigation