P1.240. Anastomotic Technique for Two-Stage Oesophagectomy: A Single-Centre Evaluation Following Introduction of a Robotic Programme

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Anastomotic leak remains one of the most consequential complications following oesophagectomy, driving morbidity, mortality, and prolonged recovery. Anastomotic technique is a key modifiable factor influencing leak risk. With the introduction of a robotic oesophagectomy programme in our unit, anastomotic practice evolved in parallel, with both open and robotic approaches increasingly adopting a linear-stapled technique over a handsewn approach. We evaluated whether this change in anastomotic strategy was associated with differences in leak rates following two-stage oesophagectomy. Methods A retrospective study of consecutive two-stage oesophagectomies performed between January 2021 and December 2025 was performed. Anastomotic technique was classified as handsewn or linear-stapled based on operative electronic records. The linear-stapled anastomosis was performed using a linear tri-stapler (Intuitive SureForm or Medtronic Endo GIA) with closure of the common enterotomy using a continuous two-layer barbed V-Loc suture. The handsewn anastomosis was performed as a single-layer interrupted technique. The primary outcome was anastomotic leak. Secondary outcomes included length of stay, return to theatre, and in-hospital mortality. Statistical analysis was conducted using R. Results A total of 199 two-stage oesophagectomies were performed during the study period including 52 by robotic approach and 147 via open approach. Anastomotic technique included 137 handsewn and 62 linear stapled anastomoses. A greater proportion of linear stapled cases were performed using a robotic approach (p<0.001). Anastomotic leak occurred in 22/137 (16.1%) handsewn cases compared with 1/62 (1.6%) linear-stapled cases (p=0.002). According to ECCG classification, there were 9 type I leaks, 11 type II leaks, and 3 type III leaks; the single leak in the linear-stapled group was type II. Two patients required re-operation with thoracotomy and washout, 4 were managed with endoscopic vacuum therapy, and the remainder were treated conservatively with antibiotics. There were no statistically significant differences between groups in length of stay, return to theatre, or in-hospital mortality. Conclusion In this single-centre service evaluation, linear stapled anastomosis was associated with a lower anastomotic leak rate following two-stage oesophagectomy. As institutional experience and case numbers continue to increase, further data will provide greater insight into the relative contributions of surgical approach and anastomotic technique to leak reduction.