Comparison of Short-Term Outcomes Between Intussuscepted and Non-Intussuscepted Anastomosis: A Multicenter Prospective Clinical Trial

Background Previous studies have suggested that intussuscepted anastomosis may reduce anastomotic leakage and decrease the occurrence of gastroesophageal reflux. We conducted a multicenter clinical trial to compare anastomosis-related complications, short-term patient-reported symptoms, and quality of life between intussuscepted and non-intussuscepted anastomosis. Methods Esophageal cancer patients scheduled for McKeown esophagectomy between 2023 and 2024 were included. Patients with a history of palliative resection or other malignancies were excluded. The experimental group received intussuscepted anastomosis, and the control group received non-intussuscepted anastomosis. Baseline data collected included age, gender, smoking and alcohol consumption history, BMI, acceptance of neoadjuvant therapy, tumor location, staging, and commorbidites. Surgical time, bleeding volume, positive margin rate, and the incidence of anastomotic leakage, stenosis, and recurrence within 6 months were statistically analyzed. Patients were followed up for symptoms and quality of life using questionnaires at 1, 3, and 6 months post-surgery. Results A total of 12 centers enrolled 266 patients, with 114 in the experimental group and 152 in the control group. Baseline data showed no significant differences, except for age and comorbidities. After adjusting for confounders, the incidence of anastomotic leakage was lower in the experimental group (OR: 0.166, P = 0.014). No difference in anastomotic stenosis was found (P = 1.000). A significant reduction in severe gastroesophageal reflux was observed in the experimental group at 1, 3, and 6 months after surgery(P = 0.003). Quality of life, including insomnia and reflux scores, was significantly better in the experimental group (P = 0.008 and P = 0.009). Conclusion Intussuscepted anastomosis significantly reduces the incidence of anastomotic leakage, severe gastroesophageal reflux and quality of life in the short term, compared to non-intussuscepted anastomosis. No significant difference in the incidence of anastomotic stenosis was observed between the two groups.