Browse by author
Lookup NU author(s): Arul Immanuel
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2025.Background: The optimal technique for intrathoracic esophagogastric anastomosis in esophagectomy remains undetermined. This study evaluates different anastomotic techniques in robot-assisted minimally invasive esophagectomy (RAMIE) and their impact on anastomotic leakage rates. Materials and Methods: This observational, retrospective, comparative cohort study analyzed data obtained from the Upper GI International Robotic Association (UGIRA) Esophageal Registry. All consecutive patients with a histologically proven esophageal malignancy who underwent RAMIE with intrathoracic esophagogastrostomy were included. The anastomotic technique was performed based on the clinical judgement and expertise of each individual surgeon. For comparison, the four most common techniques were included: circular end-to-side, linear side-to-side, handsewn end-to-side, and handsewn end-to-end. The primary endpoint of this study was the occurrence of anastomotic leakage, defined by the Esophagectomy Complications Consensus Group as a full-thickness gastrointestinal defect involving the esophagus, anastomosis, staple line, or conduit, regardless of its presentation or method of identification. Results: Between 2016 and September 2023, 1518 patients were included. Univariable analysis demonstrated that the linear stapled side-to-side anastomosis was associated with the lowest anastomotic leakage rate (14.0%), while the handsewn end-to-end anastomosis had the highest (32.8%) (p < 0.001). The anastomotic leakage rates for circular end-to-side and handsewn end-to-side anastomoses were 19.4% and 26.9%, respectively. Multivariable analysis confirmed that anastomotic technique was independently associated with anastomotic leakage. Specifically, handsewn anastomoses were associated with a higher risk of anastomotic leakage for both end-to-side (OR 1.675, 95% CI 1.195–2.348, p = 0.003) and end-to-end (OR 2.181, 95% CI 1.403–3.390, p < 0.001) techniques compared to circular end-to-side anastomoses. Conclusions: In RAMIE, linear side-to-side and circular end-to-side stapled anastomoses are associated with lower anastomotic leakage rates compared to handsewn techniques. While acknowledging the multifactorial complexity of anastomotic leakage, these findings favor the use of mechanical stapling in clinical practice.
Author(s): Milone M, Kooij CD, Manigrasso M, Goense L, van Det MJ, Kouwenhoven EA, Gisbertz SS, Muller BP, Lingohr P, Fujita T, Fuchs HF, Bruns CJ, Krauss DT, Haveman JW, van Etten B, Perez D, Egberts J-H, Turner P, Piessen G, Benedix F, Grimminger PP, Bellaio L, Lozanovski VJ, Ferrari G, Mourregot A, Rouanet P, Holzen J-P, Juratli MA, Pascher A, Immanuel A, Luketich JD, Baker N, van Boxel GI, Harustiak T, Li H, Hubka M, Li Z, Strignano P, van Hillegersberg R, Ruurda JP
Publication type: Article
Publication status: Published
Journal: Surgical Endoscopy
Year: 2025
Volume: 39
Pages: 5604–5612
Print publication date: 01/09/2025
Online publication date: 10/07/2025
Acceptance date: 28/06/2025
Date deposited: 02/09/2025
ISSN (print): 0930-2794
ISSN (electronic): 1432-2218
Publisher: Springer
URL: https://doi.org/10.1007/s00464-025-11977-x
DOI: 10.1007/s00464-025-11977-x
PubMed id: 40640625
Altmetrics provided by Altmetric
