He Liu1, Limei Shan1, Jian Wang1, Rong Zhai1, Yining Zhu1, Fei Yao2. 1. Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China. 2. Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China. yaofei@njmu.edu.cn.
Abstract
BACKGROUND: Previous studies have proposed that the totally mechanical Collard (TMC) method may reduce anastomotic leakage and stricture. This study aimed to compare the TMC method and the circular stapled (CS) method for cervical anastomosis after minimally invasive esophagectomy (MIE) for esophageal cancer. METHODS: From May 2017 to September 2020, 308 patients (165 in the CS group and 143 in the TMC group) were included in this study. The primary endpoints were anastomotic leakage and anastomotic stricture within 12 months. Propensity score matching was used to control potential selection bias. RESULTS: Anastomotic leak, anastomotic stricture, and refractory stricture (≥ 3 dilations) occurred in 30 (9.7%), 28 (9.1%), and 18 (5.8%) patients, respectively. The rate of anastomotic leak was similar in the CS and TMC methods (9.7 vs. 9.8%; P = 0.978), but anastomotic stricture (3.5 vs. 13.9%; P = 0.001) and refractory stricture (2.8 vs. 9.1%, P = 0.022) occurred less frequently in the TMC method. Propensity score matching yielded 128 patient pairs and confirmed these results. Multivariable analyses found that CS method, anastomotic leakage, and diabetes were independent predictors for both anastomotic stricture and refractory stricture. Subgroup analysis revealed that for patients with anastomotic leakage, the postoperative hospital stay in the TMC group was significantly longer than that in the CS group. CONCLUSION: In cervical anastomosis after MIE, the TMC method is superior to the CS method regarding anastomotic stricture and refractory stricture formation. However, compared to the CS method, the TMC method cannot lower the probability of anastomotic leakage, and anastomotic leakage with the TMC method requires a longer healing time.
BACKGROUND: Previous studies have proposed that the totally mechanical Collard (TMC) method may reduce anastomotic leakage and stricture. This study aimed to compare the TMC method and the circular stapled (CS) method for cervical anastomosis after minimally invasive esophagectomy (MIE) for esophageal cancer. METHODS: From May 2017 to September 2020, 308 patients (165 in the CS group and 143 in the TMC group) were included in this study. The primary endpoints were anastomotic leakage and anastomotic stricture within 12 months. Propensity score matching was used to control potential selection bias. RESULTS: Anastomotic leak, anastomotic stricture, and refractory stricture (≥ 3 dilations) occurred in 30 (9.7%), 28 (9.1%), and 18 (5.8%) patients, respectively. The rate of anastomotic leak was similar in the CS and TMC methods (9.7 vs. 9.8%; P = 0.978), but anastomotic stricture (3.5 vs. 13.9%; P = 0.001) and refractory stricture (2.8 vs. 9.1%, P = 0.022) occurred less frequently in the TMC method. Propensity score matching yielded 128 patient pairs and confirmed these results. Multivariable analyses found that CS method, anastomotic leakage, and diabetes were independent predictors for both anastomotic stricture and refractory stricture. Subgroup analysis revealed that for patients with anastomotic leakage, the postoperative hospital stay in the TMC group was significantly longer than that in the CS group. CONCLUSION: In cervical anastomosis after MIE, the TMC method is superior to the CS method regarding anastomotic stricture and refractory stricture formation. However, compared to the CS method, the TMC method cannot lower the probability of anastomotic leakage, and anastomotic leakage with the TMC method requires a longer healing time.
Authors: James D Luketich; Arjun Pennathur; Omar Awais; Ryan M Levy; Samuel Keeley; Manisha Shende; Neil A Christie; Benny Weksler; Rodney J Landreneau; Ghulam Abbas; Matthew J Schuchert; Katie S Nason Journal: Ann Surg Date: 2012-07 Impact factor: 12.969
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Authors: Donald E Low; Derek Alderson; Ivan Cecconello; Andrew C Chang; Gail E Darling; Xavier Benoit DʼJourno; S Michael Griffin; Arnulf H Hölscher; Wayne L Hofstetter; Blair A Jobe; Yuko Kitagawa; John C Kucharczuk; Simon Ying Kit Law; Toni E Lerut; Nick Maynard; Manuel Pera; Jeffrey H Peters; C S Pramesh; John V Reynolds; B Mark Smithers; J Jan B van Lanschot Journal: Ann Surg Date: 2015-08 Impact factor: 12.969