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End-to-End Versus End-to-Side Hand-Sewn Anastomosis for Minimally Invasive McKeown Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Standard anastomotic configuration for esophagogastric anastomosis is not conclusive. This study aimed to compare the short-term outcomes of end-to-end (ETE) cervical double-layer hand-sewn anastomoses with those of end-to-side (ETS) anastomoses for minimally invasive McKeown esophagectomy.

Methods

Between January 2016 and December 2017, the clinical data of 252 consecutive patients who underwent minimally invasive esophagectomy were reviewed retrospectively. The 252 patients comprised 130 patients in the ETS group and 122 patients in the ETE group. The same surgical procedures were applied in both groups, except for esophagogastric reconstruction. Short-term outcomes including leakage, stricture, reflux, operative features, and other surgical complications were analyzed for a comparison of the two configurations.

Results

The ETS and ETE groups did not differ significantly in terms of leakage rate (P = 0.34), anastomotic stricture rate (P = 0.70), or postoperative reflux (P = 0.66). However, the ETS group had a longer operation time (P = 0.011), a longer anastomosis time (P < 0.001), and a longer postoperative hospital stay (P = 0.009) than the ETE group, and the postoperative gastric dilation rates were lower in ETE group than in the ETS group (P = 0.025). The two groups did not differ significantly in terms of other postoperative complications.

Conclusions

The major postoperative complications were comparable for the two anastomotic configurations. However, the patients with ETE anastomosis showed a favorable outcome in terms of a decreasing postoperative thoracic gastric dilation rate. End-to-end anastomosis also seemed to have slight advantages in terms of shorter operation and anastomosis times as well as a shorter postoperative hospital stay.

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Acknowledgment

This study was funded by the National Natural Science Foundation of China (81500419) and the Sichuan Science and Technology Program (2018HH0150), and did not receive any commercial interest support.

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Author notes

  1. Cheng-Yi Mao and Yu-Shang Yang contributed equally to the study and share first authorship.

Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China

    Cheng-Yi Mao MD, Yu-Shang Yang MD, PhD, Yong Yuan MD, PhD, Wei-Peng Hu MD, Yong-Fan Zhao MD, Yang Hu MD, PhD, Guo-Wei Che MD, PhD & Long-Qi Chen MD, PhD

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  1. Cheng-Yi Mao MD
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  2. Yu-Shang Yang MD, PhD
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  3. Yong Yuan MD, PhD
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  6. Yang Hu MD, PhD
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Correspondence to Yong Yuan MD, PhD.

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Mao, CY., Yang, YS., Yuan, Y. et al. End-to-End Versus End-to-Side Hand-Sewn Anastomosis for Minimally Invasive McKeown Esophagectomy. Ann Surg Oncol 26, 4062–4069 (2019). https://doi.org/10.1245/s10434-019-07630-2

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  • DOI: https://doi.org/10.1245/s10434-019-07630-2

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