Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study.

OBJECTIVE: Compare the postoperative outcome of the hand-sewn method and the staple method of primary esophagogastric anastomosis after esophagectomy in patients with esophageal carcinoma. The study focused on leakage, stricture rates, operative time, blood loss, and complication.

MATERIAL AND METHOD: A prospective randomized trial was undertaken in 117 patients with squamous cell carcinoma of the thoracic esophagus who underwent Ivor-Lewis esophagectomy. Patients were classified according to esophageal size, based on the diameter of the divided esophagus (< or > 30 mm) and then were randomized to have primary anastomosis using either hand-sewn or stapled method.

RESULTS: The mean total operating time of esophagectomy when using hand-sewn technique and staple technique were 218.1 +/- 47.8 minutes and 203.7 +/- 23.4 minutes, respectively (p = < 0.001). The mean blood loss in the handsewn group and in the staple group was 864 +/- 346.6 mls and 803 +/- 301.2 mls, respectively (p = 0.02). Anastomotic leakage was 6.7% in the hand-sewn group and 3.4% in the staple group (p = 0.69). Pulmonary and cardiac complications were 13.5% and 16.9% in the hand-sewn group compared with 17.2% and 18.9% in the staple group (p = 0.77, p = 0.96). Anastomotic stricture was found in 10 of 52 patients (19.2%) in the handsewn group and 19 of 52 patients (36.5%) in the staple group (p = 0.08). In the patients with a small esophagus, the stricture rate was significantly lower in the hand-sewn group compared with the staple group (15.2% vs. 38.8%) (p = 0.03). Mortality rate in both groups were not significantly different (11.8% vs. 10.3%) (p = 0.97).

CONCLUSION: From the present study, it can be concluded that both hand-sewn method and the staple method in primary esophagogastric anastomosis after esophagectomy in the patients with esophageal carcinoma were safe. The stapled method had a higher incidence of anastomotic stricture especially small esophagus, whereas it consumed less operative time and less blood loss.