COMPARISON OF HAND-SEWN AND STAPLED ESOPHAGOGASTRIC ANASTOMOSIS AFTERESOPHAGEAL RESECTION FOR CANCER - A PROSPECTIVE RANDOMIZED CONTROLLEDTRIAL

Objective The objective of this study was to compare the hand-sewn and stapled methods in esophagogastric anastomosis. Summary Background Da ta After esophageal resection for cancer, the relative merits of the h and-sewn and the stapled methods of esophagogastric anastomosis, espec ially regarding leakage and stricture rates, have not adequately been studied. Methods A prospective randomized controlled trial was underta ken in 122 patients with squamous cell cancer of the thoracic esophagu s who underwent a Lewis-Tanner esophagectomy. Patients were stratified according to esophageal size, based on the diameter of the divided es ophagus (< or greater than or equal to 30 mm) and then were randomized to have either a hand-sewn or a stapled anastomosis. Results The mean total operating times (standard error of the mean) when the hand-sewn and the stapled methods were used were 214 (4) minutes and 217 (3.4) minutes, respectively (p = not significant [NS]). The respective in vi vo proximal resection margins (standard error of the mean) were 8 (0.4 ) cm and 7.6 (0.4) cm (p = NS). Leakage rates were 1.6% and 4.9% (p = NS). Excluding hospital deaths, patients with leakage or anastomotic r ecurrence, and those who received radiation therapy to histologically infiltrated resection margin, anastomotic stricture was found in 5 (9. 1%) of 55 patients in the hand-sewn group and 20 (40%) of 50 in the st apler group (p = 0.0003). The difference in stricture rates was signif icant in small as well as large esophagi. Anastomotic recurrence devel oped in only one patient in each group. Conclusions The authors conclu de that both methods were safe, but the stapled technique resulted in more stricture formation.