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document
Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer : a prospective randomized controlled trial . OBJECTIVE The objective of this study was to compare the hand-sewn and stapled methods in esophagogastric anastomosis . SUMMARY BACKGROUND DATA After esophageal resection for cancer , the relative merits of the hand-sewn and the stapled methods of esophagogastric anastomosis , especially regarding leakage and stricture rates , have not adequately been studied . METHODS A prospective randomized controlled trial was undertaken in 122 patients with squamous cell cancer of the thoracic esophagus who underwent a Lewis-Tanner esophagectomy . Patients were stratified according to esophageal size , based on the diameter of the divided esophagus ( < or > or = 30 mm ) and then were randomized to have either a hand-sewn or a stapled anastomosis . RESULTS The mean total operating times ( standard error of the mean ) when the hand-sewn and the stapled methods were used were 214 ( 4 ) minutes and 217 ( 3.4 ) minutes , respectively ( p = not significant [ NS ] ) . The respective in vivo proximal resection margins ( standard error of the mean ) were 8 ( 0.4 ) cm and 7.6 ( 0.4 ) cm ( p = NS ) . Leakage rates were 1.6 % and 4.9 % ( p = NS ) . Excluding hospital deaths , patients with leakage or anastomotic recurrence , and those who received radiation therapy to histologically infiltrated resection margin , anastomotic stricture was found in 5 ( 9.1 % ) of 55 patients in the hand-sewn group and 20 ( 40 % ) of 50 in the stapler group ( p = 0.0003 ) . The difference in stricture rates was significant in small as well as large esophagi . Anastomotic recurrence developed in only one patient in each group . CONCLUSIONS The authors conclude that both methods were safe , but the stapled technique resulted in more stricture formation .
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Intervention_Surgical
hand-sewn
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Intervention_Surgical
stapled esophagogastric anastomosis
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Intervention_Surgical
hand-sewn
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Intervention_Surgical
stapled
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Intervention_Surgical
esophagogastric anastomosis .
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Intervention_Surgical
Lewis-Tanner esophagectomy .
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Intervention_Surgical
hand-sewn
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Intervention_Surgical
stapled anastomosis
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Outcome_Physical
leakage
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Outcome_Physical
stricture
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Outcome_Other
mean total operating times
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Outcome_Other
vivo proximal resection margins
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Outcome_Adverse-effects
Leakage
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Outcome_Other
rates
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Outcome_Mortality
hospital deaths
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Outcome_Physical
leakage or anastomotic recurrence
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Outcome_Physical
anastomotic stricture
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Outcome_Physical
difference in stricture rates
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Outcome_Physical
Anastomotic recurrence
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Outcome_Other
safe
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Outcome_Physical
stricture formation
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Participant_Condition
122 patients with squamous cell cancer of the thoracic esophagus who underwent a Lewis-Tanner esophagectomy .