F-055SEMIMECHANICAL ANASTOMOSIS VERSUS HAND-SEWN ANASTOMOSIS AFTER OESOPHAGECTOMY WITH GASTRIC TUBULISATION AND CERVICAL ANASTOMOSIS

Abstract

Objective: Semimechanical side-to-side stapled anastomosis is thought to reduce frequency of leaks and strictures when using whole stomach. Scarce data are available when using gastric tubulisation. Methods: Two matched groups of patients, operated between 2005 and 2008, were retrieved receiving a cervical esophagogastrostomy on gastric tubulisation: 92 semimechanical-anastomosis (SMA), 41 handsewn-anastomosis (HSA). EORTC QLC-30 and OES-18 questionnaires were used to score anastomosis related symptoms. A difference of 10 points or 10% was considered clinically significant. Results: Overall incidence of anastomotic leaks was 4.5%. Leakage rate in SMA was 2.17% versus 4.88% in HSA (p = 0.587). Dilatation occurred in 30% of SMA and 61% of HSA (p < 0.001), 15% and 49% respectively needing > 3 dilatations (p < 0.001). Both groups demonstrate an initial increase of dysphagia score, being steeper for patients with HSA (mean score 31 versus 26). Dysphagia subscales revealed at 3 months higher mean scores for solids (HSA 38 and SMA 31) than for semi-solids (HSA30 and SMA 20) and for liquids (HSA 25 and SMA 26). Dichotomized results in symptomatic/asymptomatic showed a significant higher percentage of HSApatients (33%) being symptomatic for difficulties swallowing solids compared to SMA patients (22%). HSA-patients also had a significant higher score for swallowing saliva (30 versus 20). Past 3 months no more significant differences were seen except for reflux at 1 year being 27% in HSA versus 16% for SMA. Patients in both groups gave a similar global HRQL score at all timepoints. Conclusion: Semimechanical-anastomosis results in better dysphagia scores for solids and semisolids and reduces significantly the need for dilatations, in particular repeat dilatations. The negative effect of dysphagia in the HAS group fades out over time, probably due to the treatment, i. c. dilatations. Semimechanical-anastomosis can be safely used after gastric tubulisation allowing thus resection of the lesser curvature, an important oncologic principle for distal half tumours.