Comparison of greater curvature and lesser curvature circular-stapled esophagogastrostomy after esophagectomy in patient
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ORIGINAL ARTICLE
Comparison of greater curvature and lesser curvature circular‑stapled esophagogastrostomy after esophagectomy in patients with esophageal cancer: a prospective randomized controlled trial Ken Sasaki1 · Itaru Omoto1 · Yasuto Uchikado1 · Hiroshi Okumura1 · Masahiro Noda1 · Yusuke Tsuruda1 · Yoshiaki Kita1 · Takaaki Arigami1 · Shinichiro Mori1 · Hiroshi Kurahara1 · Akihiro Nakajyo1 · Chihaya Koriyama2 · Shoji Natsugoe1 · Takao Ohtsuka1 Received: 20 May 2020 / Accepted: 11 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Using a circular stapler to create an anastomosis for esophagogastrostomy after esophagectomy is well accepted; however, it remains uncertain if the greater curvature (GC) or lesser curvature (LC) of the gastric conduit is better for the anastomosis. We conducted this prospective study to compare the integrity of esophagogastrostomy between the esophagus and the GC or LC side of the gastric conduit. Methods The subjects of this study were 70 patients who underwent esophagectomy and were randomized to a “GC” group and an “LC” group (n = 35 each). The primary and secondary end points were anastomotic leakage (AL) and anastomotic stricture (AS), respectively. Results The overall AL rate was 22.1%, without a significant difference between the groups. Stump leakage developed in eight of nine patients in the GC group, whereas leakage developed at the esophagogastric anastomosis in five of six patients in the LC group. The rate of stump leakage was significantly higher than that of esophagogastric AL in the GC group. The overall AS rate was 4.4%, with a significant difference between the groups (0% in the GC group vs. 9.1% in the LC group). Conclusions AL rates were comparable in the two groups, but the sites of leakage were significantly different. Keywords Esophagogastrostomy · Esophagectomy · Circular stapler · Anastomotic leakage
Introduction Despite recent advances in surgical devices and techniques, anastomotic leakage (AL) of the esophagogastrostomy after subtotal esophagectomy remains a major concern. Although anastomotic techniques for esophagogastrostomy, such as suturing (hand-sewn or mechanical), stapling (circular or linear), and types of anastomosis * Ken Sasaki k‑[email protected]‑u.ac.jp 1
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8‑35‑1 Sakuragaoka, Kagoshima‑shi, Kagoshima 890‑8520, Japan
Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8‑35‑1 Sakuragaoka, Kagoshima‑shi, Kagoshima 890‑8520, Japan
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(end-to-end, side-to-side, or end-to-side), have been investigated extensively, there is no clear consensus on the best technique. Furthermore, various risk factors and outcomes associated with AL following esophagectomy have been identified [1]. A gastric conduit is most commonly used as an esophageal substitute after subtotal esophagectomy in patients with esophageal cance
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