Comparison Of T Shaped Total Mechanical Side-to-side And Circular Stapled End-to-side Cervical Esophagogastric Anastomosis After Esophagectomy

Objective: To compare the outcomes between T shaped total mechanical side-to-side and circular stapled end-to-side cervical esophagogastric anastomosis after esophagectomyMethods: A prospective randomized controlled trial was undertaken in 78 patients undergoing minimally invasive Meckown esophagectomy(MIME)in department of Cardiothoracic Surgery of Wannan Medical College between May 2016 and November 2017.Patients were randomized to receive either T shaped total mechanical side-to-side cervical esophagogastric anastomosis(TSA)(N=42)or circular stapled end-to-side cervical esophagogastric anastomosis(CSA)(N=36)after esophagectomy,analysing the operating time of anastomosis,length of stay and the postoperative complications.Results: There was no significant difference between the 2 groups in the length of stay(10.9±4.6d VS 10.6±4.4d),the mortality(0% VS 2.8%)and the incidence of common postoperative complications,anastomotic leak(9.5% VS 8.3%)and anastomotic reflux(7.1% VS 11.1%)(P>0.05).The TSA group was associated with significantly fewer operating time of anastomosis(16.9±3.9min VS 26.6±1.5min),more larger diameter of anastomotic in one month and three months after the operation(17.6±3.6mm VS 9.3±1.9mm,17.3±3.6mm VS 8.9±2.1mm),lower incidence of anastomotic stenosis(9.5% VS 33.3%)(P<0.05)than the CSA group.Furthermore,it was showed that the incidence of anastomotic stenosis which not followed anastomotic leak in the TSA group was obviously lower than that in the CSA group(2.4% VS 25.0%)(P<0.01),both groups were characterized by grade I stenosis,and comparing with the CSA group,the incidence of grade I stenosis was lower in the TSA group(P<0.05).Conclusion:The technique of TSA is simply and convenient,shortens the time of anastomosis and obviously reduces the incidence of benign anastomotic stenosis.