Esophagus : official journal of the Japan Esophageal Society · 2025
Comparison of anastomotic stricture rates between 23- and 25-mm powered circular staplers in cervical esophagogastric anastomosis: a propensity-matched study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Saito Akira, Otsuka Koji, Goto Satoru, Ariyoshi Tomotake, Yamashita Takeshi, Motegi Kentaro, Komoto Masahiro, Kishimoto Yutaka, Murakami Masahiko, Aoki Takeshi
Аннотация
BACKGROUND: Circular stapler (CS) anastomosis is widely used in McKeown esophagectomy; however, anastomotic stenosis remains a significant concern. This study aimed to compare stenosis rates between newly introduced 23- and 25-mm powered CSs in cervical esophagogastric anastomosis.
METHODS: From May 2022 to February 2024, 126 patients who underwent thoracoscopic McKeown esophagectomy with retrosternal gastric conduit reconstruction were retrospectively analyzed. They were categorized into the 23-mm (n = 52) and 25-mm (n = 74) CS groups. The primary endpoint was the comparison of anastomotic stricture rates. Propensity score matching was performed to adjust for potential confounders.
RESULTS: After propensity score matching, 39 pairs were selected. The incidence of anastomotic stricture was 18.0% (7 cases) and 12.8% (5 cases) in the 23- and 25-mm CS groups, respectively (p = not significant [NS]). The incidence of anastomotic leakage and the leakage location revealed no significant differences between the two groups. A two one-sided test for equivalence was performed to compare the risk difference in stricture rates between the groups, resulting in a risk difference of 5.1% with a 90% confidence interval of - 0.087 to 0.191 and a p value of 0.041, suggesting potential equivalence.
CONCLUSION: In this study, 23- and 25-mm powered CSs achieved comparable anastomotic stricture rates in cervical esophagogastric anastomosis during McKeown esophagectomy. The newly introduced 23-mm powered CS can be a useful option, considering its easier anvil insertion into the residual esophagus when insertion of the 25-mm CS anvil is technically challenging.
METHODS: From May 2022 to February 2024, 126 patients who underwent thoracoscopic McKeown esophagectomy with retrosternal gastric conduit reconstruction were retrospectively analyzed. They were categorized into the 23-mm (n = 52) and 25-mm (n = 74) CS groups. The primary endpoint was the comparison of anastomotic stricture rates. Propensity score matching was performed to adjust for potential confounders.
RESULTS: After propensity score matching, 39 pairs were selected. The incidence of anastomotic stricture was 18.0% (7 cases) and 12.8% (5 cases) in the 23- and 25-mm CS groups, respectively (p = not significant [NS]). The incidence of anastomotic leakage and the leakage location revealed no significant differences between the two groups. A two one-sided test for equivalence was performed to compare the risk difference in stricture rates between the groups, resulting in a risk difference of 5.1% with a 90% confidence interval of - 0.087 to 0.191 and a p value of 0.041, suggesting potential equivalence.
CONCLUSION: In this study, 23- and 25-mm powered CSs achieved comparable anastomotic stricture rates in cervical esophagogastric anastomosis during McKeown esophagectomy. The newly introduced 23-mm powered CS can be a useful option, considering its easier anvil insertion into the residual esophagus when insertion of the 25-mm CS anvil is technically challenging.