Esophagus-gastric Conduit End-to-end Anastomosis:a New Circular Stapling Technique For Anastomotic Leakage Prevention

Objective:End-to-end anastomosis for thoracic esophageal or cardiac cancer is usually involves hand-sewn, triangular anastomosis and circular stapled methods. However, these techniques have been reported to be associated with a high frequency of anastomotic leakage and benign stenosis. This study aimed to design the new circular stapling technique for end-to-end anastomosis between the remnant esophageal and the gastric conduit to reduce anastomotic leakage formation after esophagectomy or cardiectomy.Methods:Clinical data from 160 patients who underwent esophageal and cardiac cancer surgery from Jan.2012 to Jun.2014 in Department of Thoracic Surgery Affiliated Tumor Hospital Xinjiang Medical University were retrospectively analyzed.76 cases received end-to-end anastomosis (experimental group), and 84 cases received end-to-side anastomosis (control group). Retrospective analysis on the occurrence rate of anastomotic leakage were conducted, and evaluated the feasibility of anastomotic leakage prevention. Results:Anastomotic leakage occurred in 2 patients (2.63%) of experimental group, but 11 patients 13.10% of control group (P=0.016). The incidence of cervical anastomotic leakage were 4,00%(1/25) in experimental group and 32.14%(9/28) in control group (.P=0.009) respectively. However, the incidence of intrathoracic anastomotic leakage were 1.96%(1/51) in experimental group and 3.57%(2/56) in control group (P=0.614) respectively. Conclusion:Compared with end-to-side anastomosis, the end-to-end anastomosis significantly reduced the frequency of cervical anastomotic leakage. Our circular stapling technique for end-to-end anastomosis is a simple, safe and feasible method, resulting in a lower incidence of cervical anastomotic leakage in reconstruction of the alimentary tract for thoracic esophageal or cardiac cancer.