A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy

Huang, Chen; Xu, Xunhai; Zhuang, Binbin; Chen, Wenshu; Xu, Xunyu; Wang, Chao; Lin, Shengmei

doi:10.1186/s12957-017-1097-4

Cited by 16 publications

(19 citation statements)

References 18 publications

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“…Yoshida et al performed TST in 33 patients, and the rate of anastomotic leakage reduced to 1.0%, compared with 13.3% after hand-sewn anastomosis (9). Huang et al reported a decrease of the incidence anastomotic leakage in a TS group compared to a CS group, although without significant difference (17). Our results are consistent with these previous studies.…”

Section: Ts Tst and Cssupporting

confidence: 91%

Comparison of circular stapling, triangulating stapling and T-shape stapling for cervical anastomosis with minimally invasive esophagectomy

Tian

et al. 2020

Ann Transl Med

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Background: The triangulating stapling (TST) and T-shape stapling (TS) methods have been proposed to decrease the incidence of anastomotic leakage after esophagectomy, but few studies have compared them to the circular stapling technique (CS). This retrospective study aimed to compare the efficacy and safety of three cervical anastomosis methods after esophagectomy. Methods: Squamous cell carcinoma patients who underwent minimally invasive esophagectomy (MIE) with CS, TST or TS anastomosis between April 2010 and June 2012 were recruited. Their clinical characteristics and short-term outcome were analyzed. Kaplan-Meier analyses compared with log-rank test were used to calculate the effect of the three types of cervical anastomosis on overall survival (OS) and disease-free survival (DFS).Results: The incidence of anastomotic leakage was 21.8% in the CS group, 7.7% in the TS group and 11.9% in the TST group (P=0.029). There were significant differences in the incidence of gastroesophageal reflux among the three groups (P<0.001). Rates of anastomotic stenosis, pulmonary infection, chylothorax and hoarseness were not different among the groups. There were significant differences in anastomotic time, operation time and hospitalization time (all P<0.001), but there was no significant difference in albumin content at 1 month after operation (P=0.226). There was no differences in long-term surgical effects of the three types of anastomosis Conclusions: Cervical esophagogastric anastomosis by TST or TS can be considered feasible and safe and with improved short-term outcome.

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Section: Ts Tst and Cssupporting

confidence: 91%

Comparison of circular stapling, triangulating stapling and T-shape stapling for cervical anastomosis with minimally invasive esophagectomy

Tian

et al. 2020

Ann Transl Med

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“…11,12,15 Additionally, a major strength of this study is the accurate comparison of anastomotic complications under objective homogenization of the gastric conduit status using ICG, which is not the case in previous comparative studies. [10][11][12][13][14][15] The CS technique has a major limitation. The anastomotic lumen is dependent on the original esophageal diameter, which leads to a high prevalence of anastomotic stricture.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that the MC technique would reduce the prevalence of anastomotic stricture from 25% to 5%. 10,11,13 To detect such a difference, a power analysis using a 2-sided test for this primary endpoint showed that a total of 98 patients would be required to have 80% power with a ¼ 0.05 (2-sided). 23 The number of enrolled patients was set at 100 in consideration of loss to followup after surgery.…”

Section: Sample Sizementioning

confidence: 99%

“…11,12 The prevalence of cervical anastomotic stricture using the MC technique reportedly ranges from 0% to 14%. [11][12][13][14][15] To date, no randomized controlled trial has been performed to compare the CS technique and the MC technique for cervical esophagogastric anastomosis after esophagectomy in patients with esophageal cancer. Thus, we performed the present randomized controlled trial to evaluate the hypothesis that the prevalence of anastomotic stricture using the MC technique is lower than that using the CS technique.…”

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confidence: 99%

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Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

Hosoi

T²,

Higaki³

et al. 2021

Annals of Surgery

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Objective: This study was performed to investigate the efficacy of the modified Collard (MC) technique for reducing anastomotic stricture after esophagectomy compared with the circular stapled (CS) technique. Summary Background Data: The currently available techniques of anastomosis after esophagectomy are associated with a significant risk of anastomotic complications. However, the optimal anastomotic technique after esophagectomy has not yet been established. Methods: We randomly allocated patients to either the CS group or the MC group. The primary endpoint was the incidence of anastomotic stricture. The secondary endpoints included the incidence of postoperative complications (including anastomotic leakage) and quality of life (QoL). All anastomoses were performed after indocyanine green evaluation for objective homogenization of blood flow to the gastric conduit between the 2 techniques. Results: Among 100 randomized patients (CS group, n ¼ 50; MC group, n ¼ 50), anastomotic strictures were observed in 18 (42%) patients in the CS group and in no patients in the MC group. There were no significant between-group differences in anastomotic leakage (CS group, 7% vs MC group, 8%; P ¼ 0.94). Quality of life domains of dysphagia and choking when swallowing at 3 months after surgery were significantly better in the MC group than in the CS group. Conclusions: The MC technique reduces the incidence of anastomotic stricture and improves postoperative quality of life. Furthermore, the incidence of anastomotic leakage is comparable between the 2 techniques based on accurate comparison under objective homogenization of the gastric conduit condition.

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“…Although healing of intestinal anastomosis has been extensively studied, the pathophysiology and contributing factors are still only partially understood; briefly, tissue ischemia, leakage, suturing technique (i.e., the use of a circular stapler), and radiotherapy have been shown to be implicated [8]. Circular stapled anastomosis is an inverted anastomosis, clamping muscular and serosal tissues between both mucosal tissues, thereby resulting in anastomotic stenosis from associated scar formation [9]. Currently, no methods capable of completely preventing anastomotic stenosis have been established.…”

Section: Discussionmentioning

confidence: 99%

Surgical Resection of Anastomotic Stenosis after Rectal Cancer Surgery Using a Circular Stapler and Colostomy with Double Orifice

Imagami

Takayama

Maeda

et al. 2019

Case Reports in Surgery

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The double stapling technique has greatly facilitated intestinal reconstruction, particularly for anastomosis after anterior resection. However, anastomotic stenosis may occur, which sometimes requires surgical treatment. Redo surgery with reresection and reanastomosis presents a high risk of complications. Treatment methods need to be selected depending on the degree and location of stenosis. In an effort to propose a new resolution, reporting new cases and sharing valid experiences are necessary. An 82-year-old man diagnosed with rectal cancer had undergone laparoscopic anterior resection. Endoscopic balloon dilation performed for anastomotic stenosis had failed. Therefore, colostomy with double orifice was constructed on the oral side at 10 cm from the stenosis. Approaching from the anal and stoma side, the anastomotic stenosis was resected using a circular stapler. The colostomy was closed 1 month after surgery. Stenosis resection using a circular stapler requires the following steps: (1) passing the center shaft through the stenosis, (2) inserting the anvil head into the oral side of the stenosis, and (3) attaching the anvil head to the center shaft. This method can resect the stenosis using a circular stapler without being affected by postoperative adhesion in the pelvis. Compared to endoscopic balloon dilation, resection of the stricture by the circular stapler is thought to be reliable. This technique is particularly effective for localized stenosis, including anastomotic stenosis. It is considered that this method is minimally invasive and is low risk for complications. This method can contribute to the useful surgical option for refractory anastomotic stenosis after anterior resection.

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A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy

Cited by 16 publications

References 18 publications

Comparison of circular stapling, triangulating stapling and T-shape stapling for cervical anastomosis with minimally invasive esophagectomy

Comparison of circular stapling, triangulating stapling and T-shape stapling for cervical anastomosis with minimally invasive esophagectomy

Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

Surgical Resection of Anastomotic Stenosis after Rectal Cancer Surgery Using a Circular Stapler and Colostomy with Double Orifice

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