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Circular-stapled esophagogastrostomy using the keyhole procedure after radical esophagectomy for esophageal cancer

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Abstract

Background

Anastomotic leakage of cervical esophagogastrostomy following radical esophagectomy for esophageal cancer has reduced over time; however, postoperative anastomotic stricture still occurs at a considerably high rate. We developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler to enlarge the anastomotic opening made with a circular stapler (CS).

Methods

We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery.

Results

Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). No differences were observed in patients’ age, sex, body mass index, performance status, American Society of Anesthesiologists physical status, Charlson’s comorbidity index, tumor histological type, tumor location, clinical stage, or preoperative treatment. A smaller stapler was used in the CS + K group (p < 0.001). Incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). Univariate analysis confirmed that CS ≤ 23 without keyhole was a significant risk factor (p = 0.001).

Conclusions

The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in cervical esophagogastric anastomosis, especially when using the smaller-sized CS.

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Acknowledgements

The authors would like to thank MARUZEN-YUSHODO Co., Ltd. (https://kw.maruzen.co.jp/kousei-honyaku/) for the English language review.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Ai Goto, Tsuyoshi Tanaka, Susumu Shibasaki, Shingo Akimoto & Koichi Suda

  2. Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan

    Tsuyoshi Tanaka & Ichiro Uyama

  3. Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan

    Masaya Nakauchi, Kazuki Inaba & Ichiro Uyama

  4. Department of Surgery, Okazaki Medical Center, Fujita Health University, Okazaki, Japan

    Kenichi Nakamura & Kenji Kikuchi

  5. Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan

    Koichi Suda

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  1. Ai Goto
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  2. Tsuyoshi Tanaka
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Contributions

AG, TT, and KS contributed to the study conception, data acquisition, data interpretation, and writing of the manuscript. SS, MN, KN, SA, KK, KI, IU, and KS contributed to the critical revision of the manuscript for important intellectual content. All the authors have approved the final submitted manuscript version and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Tsuyoshi Tanaka.

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Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

T.T. and I.U. have been funded by Medicaroid, Inc., in relation to the Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University. K.S. has also been funded by Sysmex, Co., in relation to the Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University. I.U. has received lecture fees and advisory fees from Intuitive Surgical, Inc., outside of the submitted work. K.S. has also received advisory fees from Medicaroid, Inc., outside of the submitted work.

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Informed consent was obtained from all individual participants included in this study.

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Goto, A., Tanaka, T., Shibasaki, S. et al. Circular-stapled esophagogastrostomy using the keyhole procedure after radical esophagectomy for esophageal cancer. Esophagus 20, 63–71 (2023). https://doi.org/10.1007/s10388-022-00949-y

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  • DOI: https://doi.org/10.1007/s10388-022-00949-y

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