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Abstract Objectives Esophageal cancer is a high-mortality disease. Esophagectomy is the most effective method to treat esophageal cancer, accompanied with a high incidence of post-operation complications. The anastomosis has a close connection to many severe post-operation complications. However, it remains controversial about the choice of intrathoracic anastomosis (IA) or cervical anastomosis (CA). The study was conducted to compare the clinical outcomes between the two approaches. Methods We searched databases for both randomized controlled trials (RCTs) and cohort studies comparing post-operation outcomes between IA and CA. Primary outcomes were the incidences of anastomotic leakage and mortality. Secondary outcomes were the incidences of anastomotic stenosis, pneumonia and re-operation. Results Twenty studies with a total of 7,479 patients (CA group: n = 3,183; IA group: n = 4296) were included. The results indicated that CA group had a higher incidence of anastomotic leakage than IA group (odds ratio [OR] = 2.05, 95% confidence intervals [CI] = 1.61–2.60, I2 = 53.31%, P

Background: Esophageal squamous cell carcinoma (ESCC) is a prevalent and aggressive gastrointestinal tumor, particularly in East Asia. However, there is a lack of consensus on the long-term survival outcomes of intrathoracic anastomosis and cervical anastomosis following esophagectomy. This study aims to provide a comprehensive summary of the long-term survival outcomes of these two anastomosis techniques., Methods: We employed data drawn from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database from January 2010 to December 2017. Patients were stratified into two distinct groups according to the anatomical location of anastomosis following esophagectomy: those who underwent intrathoracic anastomosis (IA Group) and those who underwent cervical anastomosis (CA Group). To account for potential confounding factors and baseline imbalances between the two groups, propensity score matching (PSM) was employed., Results: The CA Group exhibited longer OS compared to the IA Group, with a median OS of 49.10 months versus 35.87 months (HR,1.118; 95% CI: 1.118-1.412; P < 0.001) . Additionally, survival rates at 1-, 3-, and 5-years were higher in the CA Group (87%, 59%, and 48% respectively) compared to the IA Group (86%, 50%, and 39% respectively). The significance persisted even after propensity score matching (PSM) (HR: 1.164; 95% CI: 1.013-1.336; P < 0.001), inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were applied. The survival difference between CA and IA was attributed to varying extents of lymph node dissection, particularly in the upper mediastinal zone (P < 0.001)., Conclusions: In conclusion, our study suggests that there could be the potential survival advantage of CA over IA in patients undergoing esophagectomy for ESCC., (Copyright © 2024. Published by Elsevier Inc.)

Abstract Background As an extensive surgery, minimally invasive esophagectomy (MIE) has advantages in reducing morbidity and improving quality of life for patients suffering from esophageal cancer. This study aims to investigate differences between MIE and open esophagectomy (OE) for considerations of the safety of procedures, rate of tumor resection, postoperative complications, and quality of life. This paper also tends to provide some references for MIE on esophageal cancer therapy. Methods A retrospective data analysis was undertaken on 140 patients who either underwent MIE or OE for esophageal cancer with cervical anastomosis from March 2013 to May 2014 by our surgical team. Preoperative characteristics were analyzed for both groups. Differences in perioperative and oncologic outcomes were compared in operation time, intraoperative blood loss, lymph nodes retrieved, and R0-resection rate. Accordingly, a comparative analysis was conducted on complications namely anastomotic leakage, pulmonary infection, in-hospital mortality, and short-term (3 months) postoperative EORTC C30 Global health as well. Results A total of 140 patients (87 with MIE and 53 with OE) were enrolled and the two groups were homogeneous in terms of patient- and tumor-related data. There was no difference on postoperative ICU stay (21.15 ± 1.54 h vs 21.75 ± 1.68 h, p = 0.07) and R0-resection rate (100% vs 100%, p = 1.00). The operation time for MIE was significantly shorter (146.08 ± 17.35 min vs 200.34 ± 14.51 min, p

Abstract Background Mechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications. Methods In total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre‐embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Results The results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205–300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8–14 days with an average of 10.3 days. Conclusion Our data revealed that pre‐embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma. Key points This new technique can significantly reduce the risk of anastomotic leakage. This study adds further details enabling a smooth pre‐embedded procedure to be performed.

Background: The standard treatment for esophageal carcinoma is extensive resection of the tumor and esophagogastric anastomosis despite the high incidence of related anastomotic complications, such as stricture and leakage. Thus, the choice of the cervical esophagogastric anastomotic method-triangulating stapling (TS) versus circular stapling (CS)-is a critical decision for the surgeon. Aim: To compare the incidence of major adverse outcomes between TS and CS in patients with resectable thoracic esophageal cancer. Methods: For this meta-analysis, PubMed, Embase, Wiley Online Library, Google Scholar, Wanfang, and China National Knowledge Infrastructure databases were searched for subject-relevant studies by using a rigorous study protocol established according to the recommendations of the Cochrane Handbook. Anastomotic leakage, anastomotic stricture, and postoperative pulmonary complications were the primary endpoints used for comparison. Relative risk (RR) with 95% confidence intervals (CI) were calculated to assess the strength of association. Results: Six studies were selected by our inclusion/exclusion criteria and represented a total of 739 patients in our meta-analysis of TS (n = 376) versus CS (n = 363). The TS group showed a lower incidence of anastomotic stricture (RR: 0.23 [95% CI: 0.08-0.63]; P = .004) and pulmonary complications (RR: 0.57 [95% CI: 0.37-0.87]; P = .01). However, the incidence of anastomotic leakage was similar for the two groups (RR: 0.66 [95% CI: 0.41-1.09]; P = .1). Subgroup analysis of four studies in which the surgical methods were minimally invasive demonstrated the TS group to have a lower incidence of lung complications (RR: 0.55 [95% CI: 0.35-0.87]; P = .01), anastomotic leakage (RR: 0.36 [95% CI: 0.18-0.74]; P = .005), and anastomotic stricture (RR: 0.23 [95% CI: 0.05-0.98]; P = .05). Conclusion: The TS method for cervical esophagogastric anastomosis after esophagectomy had a lower incidence of anastomotic stricture and postoperative lung complications. [ABSTRACT FROM AUTHOR]

Background: As an extensive surgery, minimally invasive esophagectomy (MIE) has advantages in reducing morbidity and improving quality of life for patients suffering from esophageal cancer. This study aims to investigate differences between MIE and open esophagectomy (OE) for considerations of the safety of procedures, rate of tumor resection, postoperative complications, and quality of life. This paper also tends to provide some references for MIE on esophageal cancer therapy.Methods: A retrospective data analysis was undertaken on 140 patients who either underwent MIE or OE for esophageal cancer with cervical anastomosis from March 2013 to May 2014 by our surgical team. Preoperative characteristics were analyzed for both groups. Differences in perioperative and oncologic outcomes were compared in operation time, intraoperative blood loss, lymph nodes retrieved, and R0-resection rate. Accordingly, a comparative analysis was conducted on complications namely anastomotic leakage, pulmonary infection, in-hospital mortality, and short-term (3 months) postoperative EORTC C30 Global health as well.Results: A total of 140 patients (87 with MIE and 53 with OE) were enrolled and the two groups were homogeneous in terms of patient- and tumor-related data. There was no difference on postoperative ICU stay (21.15 ± 1.54 h vs 21.75 ± 1.68 h, p = 0.07) and R0-resection rate (100% vs 100%, p = 1.00). The operation time for MIE was significantly shorter (146.08 ± 17.35 min vs 200.34 ± 14.51 min, p <  0.0001), the intraoperative blood loss was remarkably saved (MIE vs OE, 83.91 ± 24.72 ml vs 174.53 ± 35.32 ml, P <  0.0001) and more lymph nodes were retrieved (MIE vs OE, 38.89 ± 4.31 vs 18.42 ± 3.66, P <  0.0001). There was no difference between the groups to postoperative complications and mortality. However, pulmonary infection in MIE was higher than in OE and the difference was not statistically significant (MIE vs OE, 20.75% vs 31.03%, P = 0.24). Complications such as in-hospital mortality and short-term (3 months) postoperative EORTC C30 Global health displayed no difference between both groups as well.Conclusions: The number of lymph nodes and intraoperative blood loss were significantly ameliorated in MIE. A 4-5 cm longitudinal incision below the xiphoid process was made to create the gastric conduit under direct vision assisting in shortening the total operation time significantly. [ABSTRACT FROM AUTHOR]

Background: Mechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications. Methods: In total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre‐embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Results: The results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205–300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8–14 days with an average of 10.3 days. Conclusion: Our data revealed that pre‐embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma. Key points: This new technique can significantly reduce the risk of anastomotic leakage.This study adds further details enabling a smooth pre‐embedded procedure to be performed. [ABSTRACT FROM AUTHOR]

The use of a small circular stapler (CS) has been reported to increase the incidence of benign anastomotic stricture of the intrathoracic anastomosis after esophagectomy, but no study has evaluated the effects of the CS size on cervical esophagogastrostomy. Based on a propensity-matched comparison, the present study was designed to determine whether the perioperative outcomes differ between 21- and 25-mm CSs after minimally invasive esophagectomy with cervical anastomosis. From January 2015 to December 2017, 162 patients who received CS cervical esophagogastric anastomosis after minimally invasive esophagectomy for esophageal cancer were identified from our surgical database. A propensity-matched analysis was used to compare the outcomes between the 21- and 25-mm CS groups. Endpoints included anastomotic leak, dysphagia, reflux, stricture, and other major postoperative outcomes within 6 postoperative months. There were 69 and 93 patients in the 21- and 25-mm CS groups, respectively. Propensity matching produced 57 patients in each group. The two groups were not remarkably different in benign anastomotic stricture rate (P = 0.528). All strictures were resolved by balloon dilatation. The 25-mm CS group had a significantly longer operative time in cervical anastomosis than the 21-mm group (P = 0.005). No statistically significant differences in anastomotic leak rates, dysphagia scores, reflux scores, or other postoperative complications were noted between the two groups. The use of a 21-mm CS in minimally invasive esophagectomy with cervical esophagogastric anastomosis did not result in greater anastomotic stricture as compared with a 25-mm CS. The 21-mm CS was associated with a significantly shorter operative time. [ABSTRACT FROM AUTHOR]

Introduction: Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal carcinoma. However, it is currently unknown if McKeown TMIE or Ivor Lewis TMIE should be preferred for patients in whom both procedures are oncologically feasible. Methods: The study was performed in 4 high-volume Dutch esophageal cancer centers between November 2009 and April 2017. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing McKeown TMIE or Ivor Lewis TMIE were included. Patients were propensity score matched for age, body mass index, sex, American Society of Anesthesiologists classification, Charlson Comorbidity Index, tumor type, tumor location, clinical stage, neoadjuvant treatment, and the hospital of surgery. The primary outcome parameter was anastomotic leakage requiring reintervention or reoperation. Secondary outcome parameters were operation characteristics, pathology results, complications, reinterventions, reoperations, length of stay, and mortality. Results: Of all 787 included patients, 420 remained after matching. The incidence of anastomotic leakage requiring reintervention or reoperation was 23.3% after McKeown TMIE versus 12.4% after Ivor Lewis TMIE (P = 0.003). Ivor Lewis TMIE was significantly associated with a lower incidence of pulmonary complications (46.7% vs 31.9%), recurrent laryngeal nerve palsy (9.5% vs 0.5%), reoperations (18.6% vs 11.0%), 90-day mortality (7.1% vs 2.9%), shorter median intensive care unit length of stay (2 days vs 1 day) and shorter median hospital length of stay (12 vs 11 days) (all P < 0.05). R0 resection rate was similar between the groups. The median number of examined lymph nodes was 21 after McKeown TMIE and 25 after Ivor Lewis TMIE (P < 0.001). Conclusions: Ivor Lewis TMIE is associated with a lower incidence of anastomotic leakage, 90-day mortality and other postoperative morbidity compared to McKeown TMIE in patients in whom both procedures are oncologically feasible. [ABSTRACT FROM AUTHOR]

Background: Esophagectomies are a notoriously difficult procedure that have undergone drastic changes over the last decade. In particular, the adoption of minimally invasive esophagectomies (MIEs) as the gold standard.Methods: We examine the evolution of the MIE, the support for this method, and our preferred methods for the creation of anastomoses following the resection.Results: The submission of techniques that, after many years of practice, have become our standard methods for anastomosing the Neo-esophagus to the remnant esophagus both at the neck, and within the thorax.Conclusion: No matter which MIE technique is chosen, these anastomotic methods are readily available. Each is provided with step-by-step instructions, performed with standard laparoscopic instruments, and in a safe and reproducible manner. [ABSTRACT FROM AUTHOR]

Purpose: Minimally invasive esophagectomy is increasingly performed for esophageal or gastroesophageal junctional cancer, with advantages of improved perioperative outcomes in comparison with open esophagectomy. McKeown and Ivor Lewis are widely used procedures of minimally invasive esophagectomy, and there have been controversies on which one is preferred for patients with resectable esophageal or junctional cancer. Patients and methods: This review was registered at the International Prospective Register of Systematic Reviews (number CRD42017075989). Studies in PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were thoroughly investigated. Eligible studies included prospective and retrospective studies evaluating short-term outcomes of minimally invasive McKeown esophagectomy (MIME) vs minimally invasive Ivor Lewis esophagectomy (MILE) in patients with resectable esophageal or junctional tumors. Main parameters included anastomotic leak and 30-day/in-hospital mortality. Overall incidence rates (ORs)/weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated by employing random-effects models. Results: Fourteen studies containing 3,468 cases were included in this meta-analysis. Age, male sex, and American Joint Committee on Cancer (AJCC) stage between the 2 groups were not statistically different. MIME led to more blood loss, longer operating time, and longer hospital stay than MILE. MIME was associated with higher incidence of pulmonary complications (OR =1.96, 95% CI =1.28–3.00) as well as total anastomotic leak (OR =2.55, 95% CI =1.40–4.63), stricture (OR =2.07, 95% CI =1.05–4.07), and vocal cord injury/palsy (OR =5.62, 95% CI =3.46–9.14). In addition, the differences of R0 resection rate, number of lymph modes retrieved, blood transfusion rate, length of intensive care unit stay, incidence of cardiac arrhythmia, and Chyle leak between MIME and MILE were not statistically significant. Notably, incidence of severe anastomotic leak (OR =1.28, 95% CI =0.73–2.24) and 30-day/in-hospital mortality (OR =1.76, 95% CI =0.92–3.36) as well as 90-day mortality (OR =2.22, 95% CI =0.71–6.98) between the 2 procedures were also not significantly different. Conclusion: This study suggests that MIME and MILE are comparable with respect to clinical safety. MILE may be a better option when oncologically and clinically suitable. MIME is still a safe alternative procedure when clinically indicated. However, this evidence is at risk for bias; randomized controlled trials are needed to validate or correct our results. [ABSTRACT FROM AUTHOR]

Background: Intrathoracic (vs cervical) anastomosis and a thoracotomy (vs absence) have previously been associated with increasing postoperative mortality (POM). Recent improvements in surgical practices and perioperative management may have changed these dogmas. Objectives: The aim of this study was to evaluate the impact of performing intrathoracic anastomosis and/or thoracotomy on POM after esophageal cancer surgery in recent years. Methods: All consecutive patients who underwent esophageal cancer surgery with reconstruction between 2010 and 2012 in France were included (n = 3286). Patients with a thoracoscopic approach were excluded (n = 4). We compared 30-day POM between patients having received intrathoracic (vs cervical) anastomosis and between those having received a thoracotomy or not. Multivariate analyses and propensity score matching were used to adjust for confounding factors. Results: Patients had either cervical (n = 548) or intrathoracic (n = 2738) anastomosis. Thirty-day POM was higher after cervical anastomosis (8.8% vs 4.9%, P < 0.001). Having received a thoracotomy (n = 3061) was associated with a decreased risk of 30-day POM (5.3% vs 9.3%, P = 0.011). After adjustment for confounding factors, cervical anastomosis was associated with 30-day POM [odds ratio (OR) 1.71; 95% confidence interval (CI) 1.05-2.77); P = 0.032], whereas performing a thoracotomy was not associated with 30- day POM (OR 0.97; 95% CI 0.51-1.84; P = 0.926). Conclusions: Nowadays, intrathoracic anastomosis provides a lower 30-day POM rate compared to cervical anastomosis, and performing a thoracotomy is not associated with POM. Systematic anastomosis neck placement or thoracotomy avoidance is not a relevant argument anymore to decrease POM. [ABSTRACT FROM AUTHOR]

Background: Currently, a cervical esophagogastric anastomosis (CEA) is often performed after minimally invasive esophagectomy (MIE). However, the CEA is associated with a considerable incidence of anastomotic leakage requiring reintervention or reoperation and moderate functional results. An intrathoracic esophagogastric anastomosis (IEA) might reduce the incidence of anastomotic leakage, improve functional results and reduce costs. The objective of the ICAN trial is to compare anastomotic leakage and postoperative morbidity, mortality, quality of life and cost-effectiveness between CEA and IEA afterMIE. Methods/design: The ICAN trial is an open randomized controlled multicentre superiority trial, comparing CEA (control group) with IEA (intervention group) after MIE. All patients with esophageal cancer planning to undergo curative MIE are considered for inclusion. A total of 200 patients will be included in the study and randomized between the groups in a 1:1 ratio. The primary outcome is anastomotic leakage requiring reintervention or reoperation, and secondary outcomes are (amongst others) other postoperative complications, new onset of organ failure, length of stay, mortality, benign strictures requiring dilatation, quality of life and cost-effectiveness. Discussion: We hypothesize that an IEA after MIE is associated with a lower incidence of anastomotic leakage requiring reintervention or reoperation than a CEA. The trial is also designed to give answers to additional research questions regarding a possible difference in functional outcome, quality of life and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: In China, the middle esophageal squamous cell cancer is the most common tumor type, and Mckeown esophagectomy (ME) is preferably adopted by thoracic surgeon. But, the surgical trauma of ME is great. Thoracolaparoscopic esophagectomy (TE) was developed to decrease the operative stress; however, the safety and efficacy were not defined. In this study, clinical outcomes were compared between patients who received ME and TE. Methods: The data of 113 patients who suffered from middle-thoracic esophageal cancer during the same period were collected. Sixty-two patients received ME (ME group), and 51 patients received TE (TE group). Patients' demographics and short-term clinicopathologic outcomes were comparable between the two groups. Survival rate was estimated using the Kaplan-Meier method, and comparisons between groups were performed with log-rank test. Results: Patients in TE group had lower body mass index (BMI). Preoperative tumor stage in TE group was much earlier. Both overall and thoracic operation time were longer in TE group. The blood loss during operation and postoperative day (POD) 1 was less in TE group, which contributed to the less blood transfusion. In TE group, postoperative incidence of pulmonary complications and atrial fibrillation (p = 0.035 and p = 0.033) was lower; the inflammatory response and incision pain were significantly alleviated; the ICU and in-hospital stay was shorter as well because of less surgical trauma. No statistically significant difference was found between two groups in terms of overall survival or disease-free survival. Conclusions: The efficacy and safety of TE were supported by the selected patients in this cohort study. Although it is lack of randomness in this research, some advantages of TE were gratifying such as lower postoperative complications and similar survival with ME. A multicenter prospective randomized study is now required. [ABSTRACT FROM AUTHOR]

Introduction: Pneumonia and tracheal aspiration remain problematic following esophagectomy. We hypothesized that the incidence of postesophagectomy pneumonia occurs in part because of swallowing dysfunction and more importantly silent tracheobronchial aspiration. Therefore, we instituted a routine prospective formal swallowing evaluation to determine if the aspiration rate and its associated morbidity can be decreased by early identification of patients with silent or vocal aspiration.Methods: Patients undergoing minimally invasive McKeown esophagectomy and receiving neoadjuvant chemoradiotherapy (NACR) were prospectively enrolled between December 2013 to January 2015. A standardized cineradiography observation utilizing the Rosenbek penetration-aspiration (RPA) scale was used to rule out anastomotic leak and/or aspiration.Results: Of 27 patients evaluated, twelve patients were noted to have silent (n = 8) or vocal (cough n = 4) aspiration of thin liquid (n = 8) or nectar-thick consistency (n = 4) on their initial study. Three patients were noted to have an anastomotic leak and vocal aspiration on their initial study. Eight of the nine patients who aspirated but did not have an anastomotic leak on their initial study had a repeat RPA study prior to discharge showing improvement from the initial study. Six patients (22 %) had vocal cord paresis and clinical hoarseness, but only two patients who had clinical diagnosis of pneumonia were noted to have vocal cord paresis and silent aspiration.Conclusions: Swallowing dysfunction remains a common problem after minimally invasive esophagectomy (MIE) with cervical anastomosis and can be readily identified. Silent aspiration likely contributes to pneumonia after MIE. [ABSTRACT FROM AUTHOR]

BACKGROUND. The increased incidence of accidental or non-accidental ingestion of corrosive substances or drug compounds leading to postcaustic esophagitis represents a major public health issue. The treatment of postcaustic esophagitides is difficult and long lasting, calling for a complex team trained in this borderline pathology: gastroenterologist, general surgeon, otorhinolaryngologist, anesthesiologist, psychiatrist. In cases when preventive treatment has failed, the only effective therapy remains the surgical one. MATERIAL AND METHODS. Our study involved an analysis of the cases treated and/or operated in the Department of General and Esophageal Surgery of the "Sfanta Maria" Hospital in Bucharest, between 1981-2014; respectively 195 patients who benefited from reconstructive esophageal interventions. Of the selected patients, 191 were operated for corrosive pathology produced by ingestion of caustic soda and only four cases by ingestion of acids. The lesion balance showed that, besides the esophagus, the oropharynx (28 patients), the larynx (7 patients) and the stomach (31 patients) had been affected by the corrosion process, requiring particular surgical solutions. The bypass reconstruction (preserving the esophagus) was the standard treatment, esophagectomy having been performed in only 4 patients. RESULTS. The main remote postoperative complaint was feeding inability, a consequence of various causes: cervical anastomosis stenosis, motor dysfunctions of the graft or of the laryngopharyngeal complex, over-time alteration of the graft, technical vices or the degradation of intra-abdominal assemblies, traumatic injuries of the presternal substituent. CONCLUSION. One of the most important moments during the esophageal reconstruction surgery remains the duration of the cervical anastomosis, since the postoperative complication rate and the remote functional outcome depend on it. Minimizing postoperative risks and complications requires a complete mastery of surgical methods, of the small technical "artifices" and of the necessary therapeutic refinements adapted to each individual case. [ABSTRACT FROM AUTHOR]

Backgrounds What is the optimal way for the middle esophageal cancer? It is still controversial. In this study, the clinical outcome of middle thoracic esophageal cancer with either intrathoracic or cervical anastomosis was analyzed in our department. Patients and Methods A total of 205 patients who suffered from middle thoracic esophageal cancer were divided into two groups. In group A, 91 patients received intrathoracic anastomosis above aortic arch after esophageal resection via single left thoracotomy, and in group B, 114 patients received cervical anastomosis after esophageal resection via right thoracotomy and median laparotomy. Data of these patients were collected, and morbidity and mortality were analyzed retrospectively. Survival rate was estimated using the Kaplan-Meier method and comparisons between groups were performed with log-rank test. Univariate and multivariate analyses were performed using Cox model to look for independent predictors of survival. Results Postoperative complications occurred more frequently in group B, such as hemorrhage (p = 0.011), wound infection (p = 0.032), and temporary paresis of the recurrent laryngeal nerve (p = 0.001). Morbidity of anastomotic leak was higher in group B (8.8 vs. 2.2%; p = 0.048), but the associated mortality was not increased. The extent of radical esophagectomy and lymphadenectomy was much greater in group B; therefore, longer esophagus was resected that reduced the cancer residual rate, and more positive lymph nodes were detected that enhanced the accuracy of clinical staging. Fortunately, more patients received adjuvant therapy after operation in group B, and the 5-year survival rate was improved. Conclusion Anastomotic leak rate was higher in cervical anastomosis but with lower mortality. The 5-year survival rate was improved in cervical anastomosis group. The present data support the assumption that cervical anastomosis is a safer and more beneficial procedure for patients with middle thoracic esophageal cancer. [ABSTRACT FROM AUTHOR]

The application of cervical esophagogastric anastomoses was of great concern. However, between circular stapler (CS) and hand-sewn (HS) methods with anastomosis in the neck, which one has better postoperative effects still puzzles surgeons. This study aims to systematically evaluate the effectiveness, security, practicality, and applicability of CS compared with the HS method for the esophagogastric anastomosis after esophageal resection. A systematic literature search, as well as other additional resources, was performed which was completed in January 2013. The relevant randomized controlled trials (RCTs) about the surgical technique for esophageal resection were included. Trial data was reviewed and extracted independently by two reviewers. The quality of the included studies was assessed by the recommended standards basing on Cochrane handbook 5.1.0, and the data was analyzed via RevMan 5 software (version 5.2.0). Nine studies with 870 patients were included. The results showed that in comparing HS to CS methods with cervical anastomosis, no significant differences were found in the risk of developing anastomotic leakages (relative risk (RR) = 1.30, 95 % confidence intervals (CI) 0.87-1.92, p = 0.20), as well as the anastomosis stricture (RR = 0.97, 95 % CI 0.47-1.99, p = 0.93), postoperative mortality (RR = 0.83, 95 % CI 0.43-1.58, p = 0.57), blood loss (mean difference (MD) = 39.68; 95 % CI −6.97, 86.33; p = 0.10) and operative time (MD = 18.05; 95 % CI −3.22, 39.33; p = 0.10). However, the results also illustrated that the CS methods with cervical anastomosis might be less time-consuming and have shorter hospital stay and higher costs. Based upon this meta-analysis, there were no differences in the postoperative outcomes between HS and CS techniques. And the ideal technique of cervical esophagogastric anastomosis following esophagectomy remains under controversy. [ABSTRACT FROM AUTHOR]