Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial.

OBJECTIVE

The objective of this study was to compare the hand-sewn and stapled methods in esophagogastric anastomosis.

SUMMARY BACKGROUND DATA

After esophageal resection for cancer, the relative merits of the hand-sewn and the stapled methods of esophagogastric anastomosis, especially regarding leakage and stricture rates, have not adequately been studied.

METHODS

A prospective randomized controlled trial was undertaken in 122 patients with squamous cell cancer of the thoracic esophagus who underwent a Lewis-Tanner esophagectomy. Patients were stratified according to esophageal size, based on the diameter of the divided esophagus (< or > or = 30 mm) and then were randomized to have either a hand-sewn or a stapled anastomosis.

RESULTS

The mean total operating times (standard error of the mean) when the hand-sewn and the stapled methods were used were 214 (4) minutes and 217 (3.4) minutes, respectively (p = not significant [NS]). The respective in vivo proximal resection margins (standard error of the mean) were 8 (0.4) cm and 7.6 (0.4) cm (p = NS). Leakage rates were 1.6% and 4.9% (p = NS). Excluding hospital deaths, patients with leakage or anastomotic recurrence, and those who received radiation therapy to histologically infiltrated resection margin, anastomotic stricture was found in 5 (9.1%) of 55 patients in the hand-sewn group and 20 (40%) of 50 in the stapler group (p = 0.0003). The difference in stricture rates was significant in small as well as large esophagi. Anastomotic recurrence developed in only one patient in each group.

CONCLUSIONS

The authors conclude that both methods were safe, but the stapled technique resulted in more stricture formation.