P1.241. Comparative Outcomes of Triple-Layer Hand-Sewn Versus Double Linear Stapled Cervical Esophagogastric Anastomosis Following Minimally Invasive Esophagectomy

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Cervical anastomosis after esophagectomy carries leak rates approaching 30%. Although the choice between stapled and hand-sewn techniques is often based on surgeon preference, existing literature suggests similar leak rates. However, numerous technical modifications within each approach limit the comparability across institutions. We analyzed outcomes of the double linear stapled (modified Collard) method versus the triple-layer hand-sewn anastomosis. Methods Locally advanced esophageal cancer who underwent minimally invasive esophagectomy (MIE) with cervical esophagogastric anastomosis at a single center between January 2023 and December 2025 were retrospectively reviewed. For the linear stapled (LS) side to side anastomosis, two 60-mm staplers were utilized, whereas the hand-sewn (HS) anastomosis was performed using 4-0 vicryl RB sutures (first and third layers-interrupted, mucosal layer- continuous). Oral feeding was initiated on postoperative day (POD) 6 following LS anastomosis and on POD 1 following HS anastomosis. Postoperative outcomes were systematically analyzed. Results Seventy patients were analyzed (44 LS, 26 HS). Baseline characteristics, including TNM stage, neoadjuvant therapy, surgical approach, and extent of resection, were comparable between groups, with R0 resection achieved in all cases. Anastomosis time was significantly shorter in the LS group (7 vs. 18 minutes). AL occurred in 3 patients (6.8%) in the LS group and 1 patient (3.8%) in the HS group. Stricture rates were similar (4.5% vs. 3.8%). The HS group demonstrated shorter median hospital stay (6 vs. 10 days) and earlier advancement to solid food (8 vs. 15 days). Major pulmonary complications and 30-day mortality were comparable. Functional outcomes favored HS, with markedly lower neck fullness during eating (7.6% vs. 90%) and reflux symptoms (3.8% vs. 45.4%). Conclusion Triple-layer HS anastomosis demonstrated comparable safety and oncological outcomes to LS, with faster recovery and superior functional results. These findings suggest HS may offer advantages in postoperative quality of life, though prospective multicenter studies are needed for confirmation.