title: Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck.
abstract: BACKGROUND
  Leak from cervical esophagogastric anastomosis (CEGA) following esophagectomy is associated with morbidity and poor functional outcome. To address this issue, we conducted a randomized trial comparing "hand-sewn" with "stapled side-to-side" CEGA.
  
  
  METHODS
  Of 174 patients who underwent esophageal resection and CEGA between 2004 and 2010, 87 each were randomized to "hand-sewn" and "stapled side-to-side" CEGA [ www.Clinical Trials.gov: NCT00497549]. The primary outcome measure was anastomotic leak rate. The secondary outcome measures included CEGA construction time and occurrence of anastomotic stricture during follow up.
  
  
  RESULTS
  The overall anastomotic leak rate was 17.2% (major leaks: 8 %). The leak rate was similar among the two groups (hand-sewn: 14/87, stapled: 16/87; p=0.33). The stapled anastomotic technique was faster (25 ±.5 min vs. 27 ± 5.5 min; p=0.02). The overall operative mortality and morbidity rates were 6.3 % and 40.8 %, respectively. At a median follow up of 12 (6-42) months, anastomotic stricture occurred in 24 (14.7 %) patients and was significantly more common in the "hand-sewn" group (17/82 vs. 7/81; p=0.045).
  
  
  CONCLUSIONS
  There were no differences in the leak rates and postoperative outcome between the two CEGA techniques. At follow up, anastomotic strictures occurred less frequently following stapled CEGA. The ideal CEGA technique remains elusive.
authors.affiliation: Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Room No 1005, PC block, 1st floor, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.forename: Sukanta
authors.initials: S
authors.lastname: Ray
authors.forename: Sujoy
authors.initials: S
authors.lastname: Pal
authors.forename: Sumit
authors.initials: S
authors.lastname: Sanyal
authors.forename: Nikhil
authors.initials: N
authors.lastname: Agrawal
authors.forename: Nihar Ranjan
authors.initials: NR
authors.lastname: Dash
authors.forename: Peush
authors.initials: P
authors.lastname: Sahni
authors.forename: Tushar Kanti
authors.initials: TK
authors.lastname: Chattopadhyay
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery; D004940:Esophageal Stenosis / Q000453:epidemiology / Q000209:etiology; D016629:Esophagectomy / Q000401:mortality; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome