Application Of Modified Cervical Side-to-side Stapled Anastomosis After Esophagectomy For Esophageal Carcinoma

Objective:To compare the impacts to anastomotic leakage,benign stricture and reflux esophagitis after esophagectomy for esophageal carcinoma between modified cervical side-to-side stapled anastomosis and circular stapled anastomosis.Methods:A randomized control study,according to the order of hospital admission,109 cases of middle and low thoracic esophageal carcinoma were randomly divided into the cervical side-to-side stapled anastomosis group(SSSA) and circular stapled anastomosis group(CSA)between January 2014 to June 2015.Anastomosis time,perioperative mortality and anastomotic leakage,stricture and reflux esophagitis were compared.Results:There were no statistically significant differences between the two groups with the clinical characteristics(P>0.05).There were also no statistically significant differences between the two groups with pathological type,tumor location,adjuvant therapy and surgical approach(open McKeown esophagectomy or minimally invasive McKeown esophagectomy).All patients of two groups patients reached R0 resectioN surgery,postoperative pathology confirmed the vertical cut end were negative.There were no statistically significant differences with anastomosis time,perioperative mortality,pulmoary compKcations and cardiovascular complications between two groups(P> 0.05).Cervical anastomotic leakage occurred in 2 of51 口.9%) in S%A group,but 5 of 58 in CSA group(P=0.544).The reflux esophagitis occurred in 17 of 49(34.7%) in SSSA group,it low than the CSA group,but there were no statistically significant differences(P=0.210).After I week,1 month,3 inonths,the anastomosis cite in SSSAgroup was 2.31(1.58,3.54) cm2,2.16(1.43,3.38)cm2,2.06(0.29,2.60) cm2,it was large than CSA group and there were statistically significant differences.The benign anastomotic stricture rate repectively was 2.1% (1/47) and 18.5% (10/54), the difference was statistically significant(p=0.010).Conclusion:Cervical side-to-side stapled is safe,effective and feasible,that can reduce benign anastomotic strictures.