title: [Comparative study of end-to-end cervical esophagogastric anastomosis with or without invagination after esophagectomy for cancer].
abstract: OBJECTIVE
  To assess the incidence of fistula and stenosis of cervical esophagogastric anastomosis with invagination of the esophageal stump into the gastric tube in esophagectomy for esophagus cancer.
  
  
  METHODS
  Two groups of patients with thoracic and abdominal esophagus cancer undergoing esophagectomy and esophagogastroplasty were studied. Group I comprised 29 patients who underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump segment within the stomach, in the period of 1998 to 2007 while Group II was composed of 36 patients submitted to end-to-end cervical esophago-gastric anastomosis without invagination during the period of 1989 to 1997.
  
  
  RESULTS
  In Group I, esophagogastric anastomosis by invagination presented fistula with mild clinical implications in 3 (10.3%) patients, whereas in Group II, fistulas with heavy saliva leaks were observed in 11 (30.5%) patients. The frequency of fistulas was significantly lower in Group I patients (p=0.04) than in Group II. In Group I, fibrotic stenosis of anastomoses occurred in 7 (24.1%) subjects, and 10 patients (27.7%) in Group II evolved with stenosis, while no significant difference (p=0.72) was found between the two groups.
  
  
  CONCLUSIONS
  In esophagectomy for esophagus cancer, cervical esophagogastric anastomosis with invagination presented a lower rate of esophagogastric fistula versus anastomosis without invagination. Stenosis rates in esophagogastric anastomosis proved similar in both approach with or without invagination.
authors.affiliation: Disciplina do Aparelho Digestivo da Faculdade de Medicina do ABC - São Bernardo do Campo - SP - BR. achenriques@uol.com.br
authors.forename: Alexandre Cruz
authors.initials: AC
authors.lastname: Henriques
authors.forename: Aline Biral
authors.initials: AB
authors.lastname: Zanon
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Godinho
authors.forename: Lourdes Conceição
authors.initials: LC
authors.lastname: Martins
authors.forename: Roberto
authors.initials: R
authors.lastname: Saad Junior
authors.forename: Manlio Basilio
authors.initials: MB
authors.lastname: Speranzini
authors.forename: Jaques
authors.initials: J
authors.lastname: Waisberg
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D004937:Esophageal Fistula / Q000453:epidemiology / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000453:epidemiology / Q000209:etiology; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000601:surgery*