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OBJECTIVE: Anastomotic leakage, fibrous stricture and gastroesophageal reflux are three main complications of gastroesophageal anastomosis, especially for a cervical anastomosis. Our objective is to evaluate the safety andefficacy of a new cervical anastomosistechnique (JA) by comparing it to the traditional side-to-side anastomosis (SS),the end-to-side anastomosis using a circular stapler (CS) in terms of postoperative leakage, stricture and reflux.
METHODS: A total of390 patients with segmental thoracic esophageal cancer underwent a minimally invasive esophagectomy with cervical anastomosis(192 with JA, 34 with SS and 164 with CS) in our institute from January 2013 and May 2016. A detailed description of the surgical procedure is provided and the three main postoperative complications of gastroesophageal anastomosiswere compared using three-armedcontrolledstudy. stapler (CS) in terms of postoperative leakage, stricture and reflux.
RESULTS: With regard to the incidence of anastomotic leakage and reflux, the patients who underwent Jiang’s anastomosis had a significantly lower rate than those in the SS group and CS group (Leaks: 1.0% vs. 8.8% and 8.5%, P=0.025, 0.001; Reflux: 5.7% vs. 23.5% and 18.3%, P=0.003, 0.001). The incidence of dysphagia was 10.4% with an occurrence rate of 1.5% for anastomotic strictures in the JA group. It was significant lower than that in the CS group (41.5% with 18.9%, P<0.05) but no different compared to SS group (11.8% with 2.9%).
CONCLUSIONS: The Jiang’s anastomotic techniqueremarkably reduced the incidence of gastroesophageal-anastomotic leakage, stricture and reflux and is a safe and effective technique for a minimally invasive esophagectomy. 03, 0.001). The incidence of dysphagia was 10.4% with an occurrence rate of 1.5% for anastomotic strictures in the JA group. It was significant lower than that in the CS group (41.5% with 18.9%, P<0.05) but no different compared to SS group (11.8% with 2.9%).