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Purpose <p>In cervical esophagogastric anastomosis following esophagectomy with a short residual esophagus, available anastomotic options are limited. Circular staplers (CSs) of various diameters are frequently used; however, the optimal size for minimizing postoperative complications remains unclear. We evaluated whether the newly introduced 23-mm CS reduces the incidence of anastomotic leakage and stricture compared with conventional sizes.</p> Methods <p>This retrospective study analyzed 278 patients who underwent esophagectomy followed by cervical esophagogastric anastomosis using a CS between 2013 and 2021. After the introduction of the 23-mm CS, it replaced the 25-mm CS as the preferred device. A 21-mm CS was reserved for cases in which the use of a 23-mm or 25-mm CS was unfeasible. Postoperative anastomotic leakage and stricture rates were compared according to CS diameter.</p> Results <p>The 23-mm CS was associated with significantly less anastomotic leakage than the 25-mm CS (4% vs. 15%; <i>P</i> = 0.025). The incidence of anastomotic stricture was significantly lower in the 23-mm CS than that in the 21-mm CS (27% vs. 59%; <i>P</i> &lt; 0.001), although the rates were comparable between the 23- and 25-mm CS groups. Anastomotic leakage was strongly associated with subsequent stricture development, particularly in the 21-mm CS group. Multivariate analysis identified the use of a 21-mm CS and leakage as independent risk factors for postoperative stricture.</p> Conclusion <p>A 23-mm CS may provide an optimal balance between device size and postoperative complication rates for cervical anastomosis in patients with short remnant esophagus.</p>

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Clinical outcomes of 23-mm circular stapled cervical anastomosis after esophagectomy

  • 期刊论文

  • 发表日期：

    2025年11月4日

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  • Takahito Sugase,
  • Takashi Kanemura,
  • Norihiro Matsuura,
  • Keijiro Sugimura,
  • Tomohira Takeoka,
  • Kei Yamamoto,
  • Yuki Ushimaru,
  • Yasunori Masuike,
  • Yoshitomo Yanagimoto,
  • Kazuyoshi Yamamoto,
  • Ryota Mori,
  • Masatoshi Kitakaze,
  • Masahiko Kubo,
  • Yasunari Fukuda,
  • Hisateru Komatsu,
  • Masaaki Miyo,
  • Toshinori Sueda,
  • Yoshinori Kagawa,
  • Kunihito Gotoh,
  • Shogo Kobayashi,
  • Hiroshi Miyata

摘要

Purpose

In cervical esophagogastric anastomosis following esophagectomy with a short residual esophagus, available anastomotic options are limited. Circular staplers (CSs) of various diameters are frequently used; however, the optimal size for minimizing postoperative complications remains unclear. We evaluated whether the newly introduced 23-mm CS reduces the incidence of anastomotic leakage and stricture compared with conventional sizes.

Methods

This retrospective study analyzed 278 patients who underwent esophagectomy followed by cervical esophagogastric anastomosis using a CS between 2013 and 2021. After the introduction of the 23-mm CS, it replaced the 25-mm CS as the preferred device. A 21-mm CS was reserved for cases in which the use of a 23-mm or 25-mm CS was unfeasible. Postoperative anastomotic leakage and stricture rates were compared according to CS diameter.

Results

The 23-mm CS was associated with significantly less anastomotic leakage than the 25-mm CS (4% vs. 15%; P = 0.025). The incidence of anastomotic stricture was significantly lower in the 23-mm CS than that in the 21-mm CS (27% vs. 59%; P < 0.001), although the rates were comparable between the 23- and 25-mm CS groups. Anastomotic leakage was strongly associated with subsequent stricture development, particularly in the 21-mm CS group. Multivariate analysis identified the use of a 21-mm CS and leakage as independent risk factors for postoperative stricture.

Conclusion

A 23-mm CS may provide an optimal balance between device size and postoperative complication rates for cervical anastomosis in patients with short remnant esophagus.