title: A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy.
abstract: BACKGROUND
  The delta-shaped anastomosis has been reported to reduce anastomotic complications for a decade. However, little has been written comparing this technique with the circular stapler technique. The objective of this retrospective study was to assess the safety and efficacy of cervical delta-shaped anastomosis after esophagectomy.
  
  
  METHODS
  Medical records of patients with esophageal squamous cell carcinoma who underwent McKeown (three-incision) esophagectomy between September 2013 and June 2015 were reviewed. Either circular stapled anastomosis (CSA) or delta-shaped anastomosis (DSA) was performed at the cervical stage. The clinical characteristics and short-term outcome were retrospectively assessed to identify the differences between the two groups.
  
  
  RESULTS
  A total of 81 patients were included in this study. The clinical characteristics were similar between the two groups. Cervical anastomotic leakage occurred in 3 (7.7%) of 39 patients in the DSA group and in 8 (19%) of 42 patients in the CSA group (P = 0.197). The average anastomotic orifice width was 16.1 ± 4.9 mm and 11.7 ± 2.2 mm, respectively (P < 0.001). The incidence of anastomotic stenosis was 2.6% (1/39) and 23.5% (10/42) in the DSA and CSA groups, respectively (P = 0.007). There was no significant difference in surgical duration, blood loss, pulmonary complication, postoperative mortality, time of hospitalisation and time of ICU stay between the two groups.
  
  
  CONCLUSIONS
  Delta-shaped anastomosis may be an effective alternative method for gastroesophageal anastomosis after esophagectomy, with lower incidence of leakage and stenosis.
authors.affiliation: Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St, Fuzhou, 350001, Fujian, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St, Fuzhou, 350001, Fujian, China.
authors.forename: Xunhai
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St, Fuzhou, 350001, Fujian, China.
authors.forename: Binbin
authors.initials: B
authors.lastname: Zhuang
authors.affiliation: Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St, Fuzhou, 350001, Fujian, China.
authors.forename: Wenshu
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, No. 134 East St, Fuzhou, 350001, Fujian, China. xunyuxu@sina.com.
authors.forename: Xunyu
authors.initials: X
authors.lastname: Xu
authors.affiliation: Gastrointestinal Endoscopy Center, Fujian Provincial Hospital, Fuzhou, 35001, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Radiology, Fujian Provincial Hospital, Fuzhou, 350001, China.
authors.forename: Shengmei
authors.initials: S
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
keywords: Anastomotic leakage; Esophageal cancers; Esophagogastric anastomosis; Stenosis