21- versus 25-mm Circular Staplers for Cervical Anastomosis: A Propensity-Matched Study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Short-term outcomes after transition from Sweet to thoracoscopic esophagectomy: Our experience and cost analysis.

OBJECTIVE: Thoracoscopic esophagectomy (TSE), as a minimally invasive technique, has obtained wide acceptance for treating esophageal cancer. In this study, we report our experience of the transfer from open sweet esophagectomy (OSE) to TSE and compare cost associated with the two approaches for esophageal cancer. PATIENTS AND METHODS: Data were taken through a retrospective review of operative outcomes, complications and cost of 91 patients who underwent OSE or TSE for esophageal cancer from January 2012 to June 2014. RESULTS: Among 91 patients, 48 patients underwent TSE, and 43 patients underwent OSE. Patients dealt with TSE had significantly less blood loss (152 ml vs. 204 ml, P = 0.004), shorter chest drainage time (3.3 days vs. 4.5 days, P < 0.001), less patients admitted to the Intensive Care Unit after surgery (6.3% vs. 30.2%, P = 0.003), and lower incidence of respiratory complications (16.7% vs. 37.2%, P = 0.026). However, the operative time was statistically longer in TSE group (276.0 min vs. 207.4 min, P < 0.001). The total cost (¥61,817 vs. ¥48,712, P < 0.001) and the day of surgery cost (¥29,701 vs. ¥19,446, P < 0.001) were significantly higher in the TSE group. CONCLUSION: This study shows that TSE is a safe and acceptable alternative to OSE. TSE will be more competitive if its cost can be reduced.