1. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit
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S.K. Kamarajah, R.P.T. Evans, D. Nepogodiev, J. Hodson, J.R. Bundred, I. Gockel, J.A. Gossage, A. Isik, B. Kidane, H.A. Mahendran, I. Negoi, K.E. Okonta, R. Sayyed, R. van Hillegersberg, R.S. Vohra, B.P.L. Wijnhoven, P. Singh, E.A. Griffiths, D. Alderson, J. Bundred, J. Gossage, B. Jefferies, S. McKay, I. Mohamed, K. Siaw-Acheampong, R. Vohra, K. Wanigasooriya, T. Whitehouse, A. Gjata, J.I. Moreno, F.R. Takeda, R. Guevara Castro, T. Harustiak, A. Bekele, A. Kechagias, A. Kennedy, A. Da Roit, A. Bagajevas, J.S. Azagra, L. Mejía-Fernández, J. El Kafsi, R.H. Sayyed, M. Sousa, A.S. Sampaio, R. Blanco, B. Wallner, P.M. Schneider, P.K. Hsu, S. Gananadha, V. Wills, M. Devadas, C. Duong, M. Talbot, M.W. Hii, R. Jacobs, N.A. Andreollo, B. Johnston, G. Darling, A. Isaza-Restrepo, G. Rosero, F. Arias-Amézquita, D. Raptis, J. Gaedcke, D. Reim, J. Izbicki, J.H. Egberts, S. Dikinis, D.W. Kjaer, M.H. Larsen, M.P. Achiam, J. Saarnio, D. Theodorou, T. Liakakos, D.P. Korkolis, W.B. Robb, C. Collins, T. Murphy, J. Reynolds, V. Tonini, M. Migliore, L. Bonavina, M. Valmasoni, R. Bardini, J. Weindelmayer, M. Terashima, R.E. White, E. Alghunaim, M. Elhadi, A.M. Leon-Takahashi, H. Medina-Franco, P.C. Lau, J. Heisterkamp, C. Rosman, G. Beban, R. Babor, A. Gordon, J.I. Rossaak, K.M.I. Pal, A.U. Qureshi, S.A. Naqi, A.A. Syed, J. Barbosa, C.S. Vicente, J. Leite, J. Freire, R. Casaca, R.C.T. Costa, R.R. Scurtu, S.S. Mogoanta, C. Bolca, S. Constantinoiu, D. Sekhniaidze, M. Bjelović, J.B.Y. So, G. Gačevski, C. Loureiro, M. Pera, A. Bianchi, M. Moreno Gijón, J. Martín Fernández, M.S. Trugeda Carrera, M. Vallve-Bernal, M.A. Cítores Pascual, S. Elmahi, I. Halldestam, J. Hedberg, S. Mönig, S. Gutknecht, M. Tez, A. Guner, M.B. Tirnaksiz, E. Colak, B. Sevinç, A. Hindmarsh, I. Khan, D. Khoo, R. Byrom, J. Gokhale, P. Wilkerson, P. Jain, D. Chan, K. Robertson, S. Iftikhar, R. Skipworth, M. Forshaw, S. Higgs, R. Nijjar, Y.K.S. Viswanath, P. Turner, S. Dexter, A. Boddy, W.H. Allum, S. Oglesby, E. Cheong, D. Beardsmore, N. Maynard, R. Berrisford, S. Mercer, S. Puig, R. Melhado, C. Kelty, T. Underwood, K. Dawas, W. Lewis, A. Al-Bahrani, G. Bryce, M. Thomas, A.T. Arndt, F. Palazzo, R.A. Meguid, J. Fergusson, E. Beenen, C. Mosse, J. Salim, S. Cheah, T. Wright, M.P. Cerdeira, P. McQuillan, M. Richardson, H. Liem, J. Spillane, M. Yacob, F. Albadawi, T. Thorpe, A. Dingle, C. Cabalag, K. Loi, O.M. Fisher, S. Ward, M. Read, M. Johnson, R. Bassari, H. Bui, I. Cecconello, R.A.A. Sallum, J.R.M. da Rocha, L.R. Lopes, V. Tercioti, J.D.S. Coelho, J.A.P. Ferrer, G. Buduhan, L. Tan, S. Srinathan, P. Shea, J. Yeung, F. Allison, P. Carroll, F. Vargas-Barato, F. Gonzalez, J. Ortega, L. Nino-Torres, T.C. Beltrán-García, L. Castilla, M. Pineda, A. Bastidas, J. Gómez-Mayorga, N. Cortés, C. Cetares, S. Caceres, S. Duarte, A. Pazdro, M. Snajdauf, H. Faltova, M. Sevcikova, P.B. Mortensen, N. Katballe, T. Ingemann, B. Morten, I. Kruhlikava, A.P. Ainswort, N.M. Stilling, J. Eckardt, J. Holm, M. Thorsteinsson, M. Siemsen, B. Brandt, B. Nega, E. Teferra, A. Tizazu, J.H. Kauppila, V. Koivukangas, S. Meriläinen, R. Gruetzmann, C. Krautz, G. Weber, H. Golcher, G. Emons, A. Azizian, M. Ebeling, S. Niebisch, N. Kreuser, G. Albanese, J. Hesse, L. Volovnik, U. Boecher, M. Reeh, S. Triantafyllou, D. Schizas, A. Michalinos, E. Balli, M. Mpoura, A. Charalabopoulos, D.K. Manatakis, D. Balalis, J. Bolger, C. Baban, A. Mastrosimone, O. McAnena, A. Quinn, C.B. Ó Súilleabháin, M.M. Hennessy, I. Ivanovski, H. Khizer, N. Ravi, N. Donlon, M. Cervellera, S. Vaccari, S. Bianchini, l. Sartarelli, E. Asti, D. Bernardi, S. Merigliano, L. Provenzano, M. Scarpa, L. Saadeh, B. Salmaso, G. De Manzoni, S. Giacopuzzi, R. La Mendola, C.A. De Pasqual, Y. Tsubosa, M. Niihara, T. Irino, R. Makuuchi, K. Ishii, M. Mwachiro, A. Fekadu, A. Odera, E. Mwachiro, D. AlShehab, H.A. Ahmed, A.O. Shebani, A. Elhadi, F.A. Elnagar, H.F. Elnagar, S.T. Makkai-Popa, L.F. Wong, Y.R. Tan, S. Thannimalai, C.A. Ho, W.S. Pang, J.H. Tan, H.N.L. Basave, R. Cortés-González, S.M. Lagarde, J.J.B. van Lanschot, C. Cords, W.A. Jansen, I. Martijnse, R. Matthijsen, S. Bouwense, B. Klarenbeek, M. Verstegen, F. van Workum, J.P. Ruurda, P.C. van der Sluis, M. de Maat, N. Evenett, P. Johnston, R. Patel, A. MacCormick, M. Young, B. Smith, C. Ekwunife, A.H. Memon, K. Shaikh, A. Wajid, N. Khalil, M. Haris, Z.U. Mirza, S.B.A. Qudus, M.Z. Sarwar, A. Shehzadi, A. Raza, M.H. Jhanzaib, J. Farmanali, Z. Zakir, O. Shakeel, I. Nasir, S. Khattak, M. Baig, Noor MA, H.H. Ahmed, A. Naeem, A.C. Pinho, R. da Silva, A. Bernardes, J.C. Campos, H. Matos, T. Braga, C. Monteiro, P. Ramos, F. Cabral, M.P. Gomes, P.C. Martins, A.M. Correia, J.F. Videira, C. Ciuce, R. Drasovean, R. Apostu, S. Paitici, A.E. Racu, C.V. Obleaga, M. Beuran, B. Stoica, C. Ciubotaru, V. Negoita, I. Cordos, R.D. Birla, D. Predescu, P.A. Hoara, R. Tomsa, V. Shneider, M. Agasiev, I. Ganjara, D. Gunjić, M. Veselinović, T. Babič, T.S. Chin, A. Shabbir, G. Kim, A. Crnjac, H. Samo, I. Díez del Val, S. Leturio, J.M. Ramón, M. Dal Cero, S. Rifá, M. Rico, A. Pagan Pomar, J.A. Martinez Corcoles, J.L. Rodicio Miravalles, S.A. Pais, S.A. Turienzo, L.S. Alvarez, P.V. Campos, A.G. Rendo, S.S. García, E.P.G. Santos, E.T. Martínez, M.J. Fernández Díaz, C. Magadán Álvarez, V. Concepción Martín, C. Díaz López, A. Rosat Rodrigo, L.E. Pérez Sánchez, M. Bailón Cuadrado, C. Tinoco Carrasco, E. Choolani Bhojwani, D.P. Sánchez, M.E. Ahmed, T. Dzhendov, F. Lindberg, M. Rutegård, M. Sundbom, C. Mickael, N. Colucci, A. Schnider, S. Er, E. Kurnaz, S. Turkyilmaz, A. Turkyilmaz, R. Yildirim, B.E. Baki, N. Akkapulu, O. Karahan, N. Damburaci, R. Hardwick, P. Safranek, V. Sujendran, J. Bennett, Z. Afzal, M. Shrotri, B. Chan, K. Exarchou, T. Gilbert, T. Amalesh, D. Mukherjee, S. Mukherjee, T.H. Wiggins, R. Kennedy, S. McCain, A. Harris, G. Dobson, N. Davies, I. Wilson, D. Mayo, D. Bennett, R. Young, P. Manby, N. Blencowe, M. Schiller, B. Byrne, D. Mitton, V. Wong, A. Elshaer, M. Cowen, V. Menon, L.C. Tan, E. McLaughlin, R. Koshy, C. Sharp, H. Brewer, N. Das, M. Cox, W. Al Khyatt, D. Worku, R. Iqbal, L. Walls, R. McGregor, G. Fullarton, A. Macdonald, C. MacKay, C. Craig, S. Dwerryhouse, S. Hornby, S. Jaunoo, M. Wadley, C. Baker, M. Saad, M. Kelly, A. Davies, F. Di Maggio, P. Mistry, R. Singhal, O. Tucker, S. Kapoulas, S. Powell-Brett, P. Davis, G. Bromley, L. Watson, R. Verma, J. Ward, V. Shetty, C. Ball, K. Pursnani, A. Sarela, H. Sue Ling, S. Mehta, J. Hayden, N. To, T. Palser, D. Hunter, K. Supramaniam, Z. Butt, A. Ahmed, S. Kumar, A. Chaudry, O. Moussa, A. Kordzadeh, B. Lorenzi, M. Wilson, P. Patil, I. Noaman, J. Willem, G. Bouras, R. Evans, M. Singh, H. Warrilow, A. Ahmad, N. Tewari, F. Yanni, J. Couch, E. Theophilidou, J.J. Reilly, null van Boxel Gijs, K. Akbari, D. Zanotti, B. Sgromo, G. Sanders, T. Wheatley, A. Ariyarathenam, A. Reece-Smith, L. Humphreys, C. Choh, N. Carter, B. Knight, P. Pucher, A. Athanasiou, B. Tan, M. Abdulrahman, J. Vickers, K. Akhtar, R. Chaparala, R. Brown, M.M.A. Alasmar, R. Ackroyd, K. Patel, A. Tamhankar, A. Wyman, R. Walker, B. Grace, N. Abbassi, N. Slim, L. Ioannidi, G. Blackshaw, T. Havard, X. Escofet, A. Powell, A. Owera, F. Rashid, P. Jambulingam, J. Padickakudi, H. Ben-Younes, K. Mccormack, I.A. Makey, M.K. Karush, C.W. Seder, M.J. Liptay, G. Chmielewski, E.L. Rosato, A.C. Berger, R. Zheng, E. Okolo, A. Singh, C.D. Scott, M.J. Weyant, J.D. Mitchell, Surgery, Intensive Care, Radiotherapy, Oral and Maxillofacial Surgery, Rheumatology, Medical Microbiology & Infectious Diseases, Erasmus MC other, Hematology, Gastroenterology & Hepatology, Public Health, Medical Informatics, Internal Medicine, Public Administration, Epidemiology, Erasmus School of Economics, Cell biology, Pathology, Health Services Management & Organisation (HSMO), and Molecular Genetics
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Pulmonary and Respiratory Medicine ,Esophageal Neoplasms ,Anastomosis ,Anastomotic Leak ,outcomes ,Esophageal Neoplasms/surgery ,surgical techniques ,Cohort Studies ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Necrosis ,Postoperative Complications ,Esophagectomy/adverse effects ,SDG 3 - Good Health and Well-being ,Surgical ,Surgical Stapling ,anastomotic leak ,esophageal cancer ,esophagectomy ,Anastomosis, Surgical ,Esophagectomy ,Humans ,Suture Techniques ,Anastomosis, Surgical/adverse effects ,Suture Techniques/adverse effects ,Surgical Stapling/adverse effects ,Surgery ,Postoperative Complications/etiology ,Necrosis/surgery ,Cardiology and Cardiovascular Medicine ,Anastomotic Leak/etiology - Abstract
BACKGROUND: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.METHODS: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.RESULTS: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.CONCLUSIONS: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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- 2022
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