Comparison of Two Different End-to-End Hand-Sewn Anastomoses in Patients With Esophageal Squamous Cell Carcinoma: A Retrospective Study

Abstract Background Various anastomotic techniques for esophagogastric anastomoses are currently in use, but there is controversy regarding the optimal method. In this study, we have improved the anastomoses technique (end-to-end staggered-layered embedding hand-sewn anastomoses) based on end-to-end double-layer hand-sewn anastomoses and aimed to compare the short-term outcomes between two anastomoses in patients with thoracic esophageal squamous cell carcinoma. Methods This retrospective study analyzed 186 patients who underwent minimally invasive surgery for esophageal squamous cell carcinoma from January 2018 to January 2025. All patients were operated using two types of anastomoses, respectively. All the cases were revisited in 2 weeks as well as in 4, 8, and 12 months. The patients were assessed in terms of the incidence of postoperative anastomotic leakage, anastomotic stricture, pulmonary infection, other postoperative complications as well as subjective dysphagia and reflux between the two groups. Results End-to-end staggered-layered embedding hand-sewn anastomoses was carried out in 64 (34.4%) patients, whereas end-to-end double-layer hand-sewn anastomoses was performed in 122 patients (65.6%). The incidence of anastomotic leakage and stricture was lower in staggered-layered embedding anastomoses group (2.70% vs 10.03%, P = 0.002). The incidence of anastomotic stricture was comparable between the two groups (3.74% vs 14.67%, P = 0.011). After follow-up evaluation through EAT-10 and Reflux Disease Questionnaire, patients treated via staggered-layered embedding anastomoses suffered less frequently subjective dysphagia (P = 0.002) and reflux (P = 0.032). Conclusion End-to-end staggered-layered embedding hand-sewn anastomoses is significantly effective in reducing the incidence of postoperative anastomotic leakage、stricture、subjective dysphagia and reflux compared to end-to-end double-layer hand-sewn anastomoses in patients with thoracic esophageal squamous cell carcinoma undergoing minimally invasive esophagectomy.