Comparison of the modified Collard and hand‐sewn anastomosis for cervical esophagogastric anastomosis after esophagectomy in esophageal cancer patients: A propensity score‐matched analysis

Abstract

BackgroundSeveral studies have reported that modified Collard anastomosis is useful for cervical anastomosis after esophagectomy for thoracic esophageal cancer. However, no large‐scale study has confirmed the efficacy of the modified Collard anastomosis.MethodsBetween 2008 and 2016, 398 consecutive esophageal cancer patients who underwent esophagectomy and cervical anastomosis were enrolled in this study. Patients with a short remnant cervical esophagus were excluded. We investigated the utility of the modified Collard anastomosis by comparing the results of postoperative complications using a propensity score‐matched analysis between the hand‐sewn method (HS) and the modified Collard anastomosis (MC) for esophagogastric anastomosis of the neck after esophagectomy in thoracic esophageal cancer patients.ResultsOf the 398 patients, 127 were included in the MC group and 127 were included in the HS group after propensity score matching. Clinical characteristics did not differ between the two groups. Frequency of anastomotic leakage tended to be lower in the MC group than in the HS group (3% vs. 7%, P = 0.127). Frequency of anastomotic stenosis was significantly lower in the MC group than in the HS group (13% vs. 59%, P < 0.001). Multivariate logic analysis showed that anastomotic technique (HS) and performance status were independent factors associated with anastomotic stenosis (odds ratio, 12.24 and 2.52; P‐value <0.001 and 0.047, respectively).ConclusionIn cervical esophagogastric anastomosis after esophagectomy, the modified Collard anastomosis is more suitable than hand‐sewn anastomosis in terms of reducing the frequency of anastomotic stenosis.

Modified Collardversusend‐to‐side hand‐sewn anastomosis for cervical anastomosis afterMcKeownesophagectomy

“…According to the study by Prince et al the rate of anastomotic stricture after MC was 24%, 21 and according to another study reported by Ercan et al the incidence of anastomotic stricture was 66%. 20 Sugimura et al showed that MC yielded a rate of stricture of 22%, 9 whereas the study by Behzadi et al revealed that the rate of stricture after modified Collard anastomosis was 4.6%, 22 which was lower compared with that in our study (18.8%). The insertion length of the staple in the anastomosis of the posterior wall could be the potential reason for this difference.…”

“…One of the superiorities of the modified Collard anastomosis is its large anastomotic diameter. The study of Behzadi et al 22 reported an insertion length of 45-50 mm resulting in a low stenosis rate and Sugimura et al 9 reported a 40 mm insertion length of the staple in the anastomosis. The insertion length in our study was 45 mm.…”

“…According to previously published studies, esophagectomy with MC anastomosis has been reported to have low rates of anastomotic leak and stenosis. 9 However, the optional anastomotic method after esophagectomy is still controversial. We conducted this study to compare the incidences of postoperative stricture formation and dysphagia after three years between a modified Collard anastomosis and end-to-side hand-sewn anastomosis.…”

Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

“…Despite the increase in the diameter of the anastomosis, the probability of re ux did not increase in the patients of their study (31). Sugimura and colleagues showed that frequency of re ux esophagitis tended to be lower in the mechanical group than in the hand-sewn group prior to propensity score matching (26). In our study, the length of the remaining cervical esophagus was longer than the hand-sewn group in order to create a proper anastomosis in the stapled group.…”

“…The authors showed that anastomotic leakage was less frequent in the modi ed Collard group than in the hand-sewn group but that the difference was not signi cant. Anastomotic stenosis occurred to a signi cantly lower extent in the modi ed Collard group, and the period between esophagectomy and initial dilatation was signi cantly shorter in the hand-sewn anastomosis group (26). Similarly, Ishibashi et al performed triple-stapled quadrilateral anastomosis to create esophagogastric anastomosis and reported no signi cant anastomotic leakage and stricture (27).…”