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01-07-2019 | Esophagus Resection | Original Scientific Report

The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy

Authors: Takahiro Hosoi, Tetsuya Abe, Norihisa Uemura, Eiji Higaki, Ryosuke Kawai, Jiro Kawakami, Byonggu An, Masato Nagino, Yasuhiro Shimizu

Published in: World Journal of Surgery | Issue 7/2019

Abstract

Background

Cervical anastomotic stricture after esophagectomy is a serious complication that adversely affects postoperative recovery, nutritional status and quality of life. Cervical anastomosis by a circular stapler (CS) has been widely accepted as a simple and convenient method, but anastomotic strictures are likely to occur. The aim of this study was to investigate an association between CS size and the incidence of anastomotic stricture after cervical esophagogastric anastomosis performed by a CS.

Methods

Between April 2011 and March 2016, 236 consecutive patients underwent cervical esophagogastric anastomosis by a CS via a retrosternal route after esophagectomy for esophageal cancer. These patients were divided into according to CS size for the procedure as follows: small-sized (25 mm) CS group (SG, n = 116) and large-sized (28 or 29 mm) CS group (LG, n = 120). The clinical data of patients were analyzed retrospectively to compare the two groups.

Results

Overall, anastomotic strictures were observed in 90 patients (38%). The incidence of anastomotic stricture was significantly lower in the LG than the SG (23% vs. 53%, p < 0.001) (Table 3). Chronic obstructive pulmonary disease (COPD: FEV1.0% <70%) (OR 2.35, 95% CI = 1.09–5.14; p = 0.029), anastomotic leakage (OR 8.97, 95% CI = 2.69–41.30; p < 0.001), and a small-sized CS (OR 3.42, 95% CI = 1.82–6.62; p < 0.001) were independent risk factors for anastomotic stricture in the multivariate analysis.

Conclusions

If possible, a large-sized CS should be used to prevent cervical anastomotic strictures when performing cervical anastomoses by CS.

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Title: The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy
Authors: Takahiro Hosoi
Tetsuya Abe
Norihisa Uemura
Eiji Higaki
Ryosuke Kawai
Jiro Kawakami
Byonggu An
Masato Nagino
Yasuhiro Shimizu
Publication date: 01-07-2019
Publisher: Springer International Publishing
Keywords: Esophagus Resection
Esophagus Resection
Chronic Obstructive Lung Disease
Published in: World Journal of Surgery / Issue 7/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-04938-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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