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J Thorac Cardiovasc Surg 2005;129:623-631
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer?

^a Departments of Thoracic and Cardiovascular Surgery and Biostatistics and Epidemiology
^b The Cleveland Clinic Foundation, Cleveland, Ohio

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 23, 2004; accepted for publication August 30, 2004.

^* Address for reprints: Thomas W. Rice, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave/Desk F24, Cleveland, OH 44195 (E-mail: ricet{at}ccf.org).

OBJECTIVE: We sought to compare the outcome of patients with esophageal cancer who had either modified Collard or standard hand-sewn cervical esophagogastric anastomoses in reconstruction during esophagectomy.

METHODS: From March of 1996 to October of 2002, 274 patients with esophageal cancer underwent esophagectomy with gastric replacement and cervical esophagogastric anastomosis. Beginning in March of 2001, a modified Collard technique (stapled) was used in most patients (n = 86) for cervical esophagogastric anastomosis; a standard hand-sewn technique (sewn) was used in all others (n = 188). Using a propensity score based on 8 variables (age, gender, race, surgeon, surgical approach, pathologic stage, histologic cell type, and induction chemoradiotherapy), 85 patient pairs were matched and followed for time-related events. Outcome comparisons included cervical wound infection, cervical anastomotic leak, other hospital complications, length of stay, anastomotic dilatation, reflux symptoms, and survival.

RESULTS: At 30 days, freedom from cervical wound infection was 92% for stapled versus 71% for sewn anastomoses (P = .001), and freedom from cervical anastomotic leak was 96% versus 89% (P = .09), respectively. Other hospital complications occurred in 58% and 49%, respectively (P = .17). Median length of stay was 10 days for both (P = .3). At 2 years, freedom from anastomotic dilatation was 34% for stapled versus 10% for sewn anastomoses (P < .0001), and the mean number of dilatations per patient was 2.4 versus 4.1 (P = .0001), respectively. Reflux was rare for both. Thirty-day, 6-month, and 24-month survivals were 98%, 91%, and 77% for stapled anastomoses and 98%, 88%, and 69% for sewn anastomoses (P = .3).

CONCLUSIONS: The modified Collard anastomotic technique dramatically reduces morbidity after esophagectomy. It should replace hand-sewn esophagogastric anastomoses.

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