P-190COMPARISON OF INTRATHORACIC MINIMALLY INVASIVE STAPLED AND OPEN HAND-SEWN ANASTOMOSIS AFTER OESOPHAGECTOMY FOR OESOPHAGEAL ADENOCARCINOMA

Abstract

Objectives: To compare the minimally invasive port-assisted circularly stapled (MIEA) intrathoracic oesophagogastric anastomosis with conventional open hand-sewn anastomosis (OHSA). Despite of minimally invasive oesophagectomy (MIO) the anastomosis is usually made with open technique left in the neck. Intrathoracic anastomosis is often used in open resections for oesophageal adenocarcinoma (OAC), but there are very few studies on the reliability and quality concerning MIEA and no comparison with OHSA. Methods: One hundred and fourty-seven consecutive patients (124 men, 23 women; median age 64 years; range 40-85) with OAC were operated on using two-field lymphadenectomy and intrathoracic oesophagogastric anastomosis during 2006-2012, 78 (53%) patients by means of minimally invasive approach. Neoadjuvant chemotherapy was administered on 96 (65%) patients because of locally advanced status of disease. Both groups were similar for preoperative characteristics except for the median Charlson comorbidity score, which was 5 in MIO and 4 in open group. In both groups the intraoperative frozen section confirmed tumour-free distal and proximal resection margins. Narrow gastric tube was anastomosed with oesophagus in both groups in posterior mediastinum; in MIEA using circular stapler (Ø 25 mm), in OHSA with 4-0 resorbable polydioxanone monofilament suture in two layers. Results: Operative mortality was 1.5% and overall complication rate 49% with no difference between both groups. Median number of analyzed lymph nodes was 20 in open and 17 in MIO. The operative blood loss and postoperative stay in ICU were significantly less in MIO. The rates of anastomotic leaks after MIEA were 8/78 = 10% and after OHSA 3/69 = 4% (P = 0.08). Rate of postoperative strictures causing dysphagia and necessitating 1-2 endoscopic dilations was in OHSA 29% (20/69) vs 8% (6/78) in MIEA (P = 0.001). No chronic strictures developed in either group. Conclusions: MIEA is at least as safe as OHSA. The leak rate is similar, but MIEA has less anastomotic strictures.