Cervical triangulating stapled anastomosis: technique and initial experience.

OBJECTIVE

To explore the safety and efficacy of modified cervical triangulating stapled anastomosis (TSA) for gastroesophageal anastomosis (GEA) in minimally invasive esophagectomy (MIE).

METHODS

From January 2013 to November 2013, eighty-four patients who underwent three-stage MIE was enrolled. During the cervical stage, either circular stapled (CS) or triangulating stapled (TS) anastomosis was applied for GEA. Clinical features were collected and compared to identify the differences between the two groups.

RESULTS

A total of 84 patients were included in this study. The clinical characteristics were close between the two groups. Intra-operatively, the duration of GEA was close between the two groups (18±3.4 vs. 17±2.7 min, P=0.139). Post-operatively, Cervical anastomotic leakage occurred in one (3.0%) of the 33 TS patients, but in six (11.8%) of the 51 CS patients (P=0.312). The incidence of anastomotic stenosis was 0.0% and 13.7% in the TS and CS groups, respectively (P=0.069). The overall incidence of postoperative complications was significantly lower in TS than that in CS (15.2% vs. 35.3%, P=0.043). There was no difference in the median length of hospital stay or perioperative mortality rate between the two groups.

CONCLUSIONS

TSA is a safe and effective alternative for GEA, which would probably lower the incidence of leakage and stenosis following MIE. Further studies based on larger volumes are required to confirm these findings.