ORIGINAL ARTICLES   

Minerva Chirurgica 2006 April;61(2):79-83

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

Mechanical cervical esophagogastric anastomosis after esophagectomy for cancer

Francioni F., Anile M., Venuta F., De Giacomo T., Andreetti C., Diso D., Di Stasio M., D’Ecclesia G., Liparulo V., Coloni G. F.

Dipartimento di Chirurgia Generale Specialità Chirurgiche e Trapianti di Organo “Paride Stefanini” Cattedra di Chirurgia Toracica Università degli Studi di Roma “La Sapienza”, Roma

Aim. Fibrous stenosis of the esophagogastric cervical anastomosis remains a significant complication occurring in up to one third of cases.
Trying to reduce the incidence of this complication, we describe our technique of cervical esophago-gastric anastomosis using endoscopic linear stapler which seems to reduce the incidence of fibrous stricture formation after
resection of esophageal cancer.
Methods. Between March 2000 and December 2004, 34 patients (20 males and 14 females) underwent esophagectomy using tubulized stomach for reconstruction. Mean age was 57 years. Eight patients with advanced stage (5 T3 and 3 T4) underwent induction chemotherapy. The most of patients was affected by squamous cell carcinoma. In all cases we performed cervical esophagogastric anastomosis using linear endoscopic stapler. The occurrence of postoperative anastomotic leak and development of anastomotic stricture were recorded and analyzed.
Results. All patients survived esophagectomy and 30 of them (88%) were available for postoperative follow-up at 6 months. Anastomotic leak developed in 1 case. No patient developed fibrous stenosis that required dilatation therapy.
Conclusion. Complete mechanical esophago-gastric anastomosis, using endoscopic linear stapler is effective and safe, even when a narrow gastric tube is used as esophageal substitute. These technique seems superior to other techniques to reduce the incidence of postoperative anastomotic complications.