Introduction The reduction in mortality after oesophagectomy seen over the last decade has not been matched by a reduction in anastomotic leaks with a leak rate of 5–10% accepted as a standard of care. Leaks increase postoperative mortality, morbidity and length of stay and reduce cancer survival. We present the results of a modified semi-mechanical intrathoracic anastomotic technique (SM) originally described by Orringer et al 1for the cervical anastomosis.
Method Centralisation of oesophagogastric cancer surgery took place in our region in January 2010, bringing together five surgeons from three surgical units. For consistency, all five surgeons used a standard circular stapled anastomotic technique (CS) from 2010, but the leak rate was deemed too high. As a result, three of the five surgeons (A, B, and C) changed to a modified SM technique (surgeon A changed in November 2011, surgeon B in December 2011 and surgeon C in May 2013). This anastomosis joins the obliquely cut end of the oesophagus to the side of the proximal gastric conduit with a single 25 mm firing of a 45 mm linear stapler posteriorly (ATS45, Blue cartridge, Ethicon), the remainder of the anastomosis being completed with single layer inverting interrupted 3/0 PDS. The other two surgeons (D and E) continued to use the CS technique. Anastomotic leak rates, mortality and length of stay were evaluated to test this change in technique.
Results Between Jan 2010 and February 2015 inclusive 376 patients underwent curative intent, 2-stage Ivor Lewis oesophagectomy for cancer. One patient died in hospital (0.27% mortality). The anastomotic leak rate Surgeons A, B and C using CS was 16.8%(15/92) and SM 0.8%(1/127) for surgeons D and E the rate was 10.2%(16/157). The median post-operative length of stay between groups was 11(7–56), 10(6–58) and 12(7–51) respectively.
Conclusion There was a profound reduction in anastomotic leak rate for all three surgeons who changed from circular to semi-mechanical anastomosis.
Disclosure of interest None Declared.
Orringer MB, et al. Eliminating the cervical esophagogastric anastomotic leak rate with a side to side stapled anastomosis. J Thorac Cardiovasc Surg. 2000 Feb;119(2):277-88