title: Cervical triangulating stapled anastomosis: technique and initial experience.
abstract: OBJECTIVE
  To explore the safety and efficacy of modified cervical triangulating stapled anastomosis (TSA) for gastroesophageal anastomosis (GEA) in minimally invasive esophagectomy (MIE).
  
  
  METHODS
  From January 2013 to November 2013, eighty-four patients who underwent three-stage MIE was enrolled. During the cervical stage, either circular stapled (CS) or triangulating stapled (TS) anastomosis was applied for GEA. Clinical features were collected and compared to identify the differences between the two groups.
  
  
  RESULTS
  A total of 84 patients were included in this study. The clinical characteristics were close between the two groups. Intra-operatively, the duration of GEA was close between the two groups (18±3.4 vs. 17±2.7 min, P=0.139). Post-operatively, Cervical anastomotic leakage occurred in one (3.0%) of the 33 TS patients, but in six (11.8%) of the 51 CS patients (P=0.312). The incidence of anastomotic stenosis was 0.0% and 13.7% in the TS and CS groups, respectively (P=0.069). The overall incidence of postoperative complications was significantly lower in TS than that in CS (15.2% vs. 35.3%, P=0.043). There was no difference in the median length of hospital stay or perioperative mortality rate between the two groups.
  
  
  CONCLUSIONS
  TSA is a safe and effective alternative for GEA, which would probably lower the incidence of leakage and stenosis following MIE. Further studies based on larger volumes are required to confirm these findings.
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Jingpei
authors.initials: J
authors.lastname: Li
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Shen
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Mingxiang
authors.initials: M
authors.lastname: Feng
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xi
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Yunhua
authors.initials: Y
authors.lastname: Leng
authors.affiliation: 1 Division of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China ; 2 Department of Cardio-thoracic Surgery, Jingjiang People's Hospital, Jingjiang 214500, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
keywords: Esophageal cancer (EC); gastroesophageal anastomosis (GEA); minimally invasive esophagectomy (MIE); triangulating stapled anastomosis (TSA)