Cervical esophagogastric anastomosis with a new stapler in the surgery of esophageal carcinoma.
OBJECTIVE
A new reusable circular stapler for cervical esophagogastric anastomosis (CEGA) has been used to substitute the traditional method of hand-sewn cervical anastomosis.


METHODS
Over a 2-year period (09/1998-11/2000), the stapler was engaged on operations of 112 patients with thoracic esophageal carcinoma, and the anastomosis was performed through both cervical and thoracic incision. The operative approaches were through left thoracotomy in 85 cases, and through right thoracotomy in 27 cases. The results were analyzed retrospectively.


RESULTS
All of the 112 CEGA operations were successfully performed on the patients who underwent esophageal resections, and no operative mortality and anastomotic leakage occurred. Excluding the two patients with the anastomotic recurrent carcinoma, anastomotic stricture occurred in 12 cases (10.9%, n=110). Median time to the presentation of anastomotic stricture was 4.3 months (range 2.6-25.3 months), and the median number of dilatations was 3 (range 1-5). When divided into the 24 and 26 mm groups, the respective incidences of stricture were 12.3 (7/57) and 9.4% (5/53), respectively, and the statistical results of the two sizes of staplers were essentially the same (P=0.6691). Eight patients experienced nonanastomotic-related complications (7.3%, n=110), in which there were three cases of recurrent laryngeal nerve injury, four cases of the left side pneumothorax, and one case of perforation of the proximal stomach. There was also a case of stapling gauze at anastomosis. Some of the complications were closely related to the initially improper use of the new stapler's craft.


CONCLUSIONS
The results indicate that CEGA using the new circular stapling device in surgery of the esophageal carcinoma is a very effective procedure to improve the anastomotic technique from a traditional hand-sewn anastomosis to a stapled anastomosis and can reduce the incidence of complications.
Chunwei
Feng
F
Department of Thoracic Surgery, Jiangsu Institute of Cancer Research, Baziting 42#, Nanjing, 210009, People's Republic of China. fcw@public1.ptt.js.cn
Qingzeng
Ni
N
Jianliang
Liu
L
Weiji
Wu
W
D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D004106:Dilatation / Q000379:methods; D004867:Equipment Design; D017743:Equipment Reuse; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013528:Surgical Staplers; D019616:Thoracic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome