[Comparative study of end-to-end cervical esophagogastric anastomosis with or without invagination after esophagectomy for cancer]

Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: systematic review and meta-analysis

INTRODUCTION

Postoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis.

AIM

To compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and surgical time.

METHODS

A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) using the combination of descriptors (anastomosis, surgical) and (esophagectomy) was performed.

RESULTS

Thirteen randomized trials were included, totaling 1778 patients, 889 in the hand-sewn group and 889 in the stapler group. The stapler reduced bleeding (p <0.03) and operating time (p<0.00001) when compared to hand-sewn after esophageal resection. However, stapler increased the risk of anastomotic stricture (NNH=33), pulmonary complications (NNH=12) and mortality (NNH=33). There was no significant difference in relation to anastomotic leak (p=0.76) and cardiac complications (p=0.96).

CONCLUSION

After resection of esophageal cancer, the use of stapler shown to reduce blood loss and surgical time, but increased the incidence of anastomotic stricture, pulmonary complications and mortality.

Mechanical cervical esophagogastric laterolateral anastomosis after esophagectomies

Among the challenges of esophagectomies, the cervical anastomosis remains challenging for its consequences, the main being the anastomotic stricture. The authors present a technique for an Orringer-fashion mechanical cervical laterolateral esophagogastric anastomosis, which reduces the rate of fistula and stenosis.

[Transhiatal esophagectomiy using partial sternotomy]

Transhiatal Esophagectomy offers the advantage of not requiring thoracotomy or thoracoscopy. Nevertheless, it has the disadvantage of having to be performed, at least in part, with blind, blunt dissection, with high frequency of pleural lesions, increased bleeding, among other complications. The association of median diaphragm transection with partial sternotomy allows the isolation of the esophagus completely under direct vision. The authors present the technique of transhiatal esophagectomy with partial sternotomy.