End-to-End Versus End-to-Side Hand-Sewn Anastomosis Following Esophago-Gastrostomy After Oesophageal Resection for Carcinoma Oesophagus

Background: Anastomotic leakage and stricture are leading causes of morbidity following oesophageal resection for carcinoma oesophagus. The standard and optimal site of anastomosis and anastomotic technique for esophagogastric reconstruction is not conclusive, and data is limited. This study is to compare short term outcomes of single-layered hand-sewn cervical end-to-side (ETS) anastomosis with end-to-end (ETE) anastomosis following esophagectomy. Materials and Methods: Between May 2013 to May 2019, the clinical data of 126 consecutive patients who underwent transthoracic, trans hiatal or minimally invasive esophagectomy at a single academic centre were reviewed retrospectively. The 126 patients comprised 64 patients in the ETE group and 62 patients in the ETS group. All patients are followed up for a minimum period of 1 year. Short-term outcomes including leakage, stricture, operative features and other surgical complications were analysed for a comparison of the two configuration. Results: The anastomotic leak rate was significantly lower in the ETE group (28.1% vs. ETS 48.4%, p =0.019). Patients with an ETE anastomosis suffered less from anastomotic stricture (7.8% vs. ETS 16.1%, p =0.123) after 1 year of follow-up but the difference was not statistically significant.Duration of surgery is more in the end to end group with a p-value of 0.038. However the two group did not differ significantly in the duration ofhospital stay, day of initiation of oral intake, 90-day mortality and other postoperative complications.Smoking is another factor strongly related to the anastomotic leak (p=0.0035). Conclusion: ETE cervical esophagogastric anastomosis, compared to ETS anastomosis, was found to have a significant impact in reducing the anastomotic leak. Early and continued oral soft diet and wound care in leak patients help to reduce the stricture rate than keeping the patient nil per oral. Smoking is another factor strongly related to the anastomotic leak.