Jonson Ellen, Gottlieb-Vedi Eivind, Mattsson Fredrik, Putila Emilia, Sirviö Ville E J, Kauppila Joonas H, Lagergren Jesper
Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Eur J Surg Oncol. 2025 Aug;51(8):110107. doi: 10.1016/j.ejso.2025.110107. Epub 2025 Apr 29.
It is uncertain which type of anastomosis carries the lowest risk of anastomotic insufficiency after oesophagectomy for oesophageal cancer. We aimed to compare handsewn with stapled anastomosis (any type, linear or circular), and handsewn end-to-side with handsewn end-to-end anastomosis.
This bi-national population-based cohort study included almost all patients (>95 %) who underwent oesophagectomy for cancer in Sweden from 2011 to 2020 or in Finland from 2004 to 2016. Multivariable logistic regression produced odds ratios (OR) with 95 % confidence intervals (CI), adjusted for age, sex, comorbidity, tumour histology, neoadjuvant chemo(radio)therapy, surgical approach, anastomosis location, hospital volume, and pathological tumour stage.
Among 2166 study patients, 327 (15 %) had anastomotic insufficiency. The risk of anastomotic insufficiency was borderline significantly decreased in handsewn anastomosis compared to stapled anastomosis (OR = 0.79, 95 % CI 0.60-1.05). In patients who underwent minimally invasive oesophagectomy, handsewn anastomosis was associated with a decreased risk compared to stapled anastomosis (OR = 0.55, 95 % CI 0.35-0.85; n = 999), while no such association was found after open oesophagectomy (OR = 1.04, 95 % CI 0.72-1.51; n = 1167). There were no statistically significant associations with anastomotic insufficiency when comparing linear stapled with circular stapled anastomosis (OR = 1.27, 95 % CI 0.70-2.28; n = 736) or handsewn with circular stapled anastomosis (OR = 0.94, 95 % CI 0.63-1.40; n = 1324). Handsewn end-to-side anastomosis was associated with a borderline increased risk of anastomotic insufficiency compared to handsewn end-to-end anastomosis (OR = 1.61, 95 % CI 0.93-2.78; n = 786).
Regarding anastomotic insufficiency, handsewn anastomosis may be favourable compared to stapled in minimally invasive oesophagectomy for oesophageal cancer, while no such benefit was found for open oesophagectomy.
食管癌食管切除术后，尚不确定哪种吻合方式吻合口漏风险最低。我们旨在比较手工缝合与吻合器吻合（任何类型，直线型或圆形），以及手工缝合端侧吻合与手工缝合端端吻合。
这项基于两国人群的队列研究纳入了2011年至2020年在瑞典或2004年至2016年在芬兰接受癌症食管切除术的几乎所有患者（>95%）。多变量逻辑回归得出比值比（OR）及95%置信区间（CI），并对年龄、性别、合并症、肿瘤组织学、新辅助放（化）疗、手术方式、吻合位置、医院手术量和病理肿瘤分期进行了调整。
2166例研究患者中，327例（15%）发生吻合口漏。与吻合器吻合相比，手工缝合吻合口漏风险有临界显著降低（OR = 0.79，95% CI 0.60 - 1.05）。在接受微创食管切除术的患者中，与吻合器吻合相比，手工缝合吻合口漏风险降低（OR = 0.55，95% CI 0.35 - 0.85；n = 999），而在开放食管切除术后未发现这种关联（OR = 1.04，95% CI 0.72 - 1.51；n = 1167）。比较直线型吻合器吻合与圆形吻合器吻合（OR = 1.27，95% CI 0.70 - 2.28；n = 736）或手工缝合与圆形吻合器吻合（OR = 0.94，95% CI 0.63 - 1.40；n = 1324）时，与吻合口漏无统计学显著关联。与手工缝合端端吻合相比，手工缝合端侧吻合吻合口漏风险有临界增加（OR = 1.61，95% CI 0.93 - 2.78；n = 786）。
关于吻合口漏，在食管癌微创食管切除术中，与吻合器吻合相比，手工缝合可能更具优势，而在开放食管切除术中未发现此类益处。
