Modified layered hand-sewn versus circular stapled anastomosis during McKeown esophagectomy in esophageal cancer patients: A retrospective cohort study

BACKGROUNDModified layered hand-sewn (HS) end-to-side anastomosis and conventional circular stapled (CS) anastomosis are the most commonly applied surgical approaches during McKeown esophagectomy for esophageal cancer, but there is no consensus on which offers the best anastomotic outcome. AIMTo compare postoperative complications and the quality of life between HS and CS anastomosis during McKeown esophagectomy in esophageal cancer patients. METHODSA retrospective study was performed in patients who underwent McKeown threeincision esophagectomy due to squamous cell carcinoma of the upper, middle, or lower thoracic esophagus between October, 2021, and January, 2025.Patients were assigned to an HS group or CS group.Baseline characteristics were documented.Intraoperative and postoperative measurements, complications, and patient-reported outcomes at 3 months after surgery were recorded and compared between two groups. RESULTSA total of 80 patients were included, with 40 patients in either the HS or CS groups.The inter-group baseline characteristics were comparable (all P > 0.05).The operative duration and intraoperative blood loss were also similar between both groups.However, the length of postoperative hospital stay was shorter in HS than CS group (11.24 ± 2.14 days vs 12.80 ± 3.16 days, P = 0.010).The incidence of anastomotic stricture was significantly lower in HS than CS group (5% vs 20%, P = 0.043).The incidence of anastomotic leakage was also lower in HS than CS group, although without statistically 4 / 34 significantly difference (2.5% vs 10%, P = 0.359).At 3 months postoperatively, the patients in the HS group demonstrated a better swallowing function, improved eating function, and improved nutritional status (all P < 0.05). CONCLUSIONIn patients undergoing McKeown esophagectomy due to squamous cell carcinoma of the upper, middle, or lower thoracic esophagus, modified layered HS anastomosis could significantly reduce the risk of anastomotic stricture compared with conventional CS anastomosis.It also required a shorter length of postoperative hospital stay and offered a better quality of life for patients.Modified layered HS anastomosis could be considered a viable option for experienced surgeons to use in such patients.