Supercharged cervical anastomosis for esophagectomy and gastric pull-up

Abstract

Objective: Esophagectomy has high rates of morbidity and mortality. Anastomotic leakage is the most frequent complication and is likely caused by diminished anastomotic perfusion. Supercharged microvascular anastomosis has previously been performed in select patients to supplement the blood supply to the graft and anastomosis after esophagectomy. This study aimed to evaluate complications that may arise after performing the supercharged cervical anastomosis for esophagectomy procedure.

Methods: This prospective comparative study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were divided into group 1, in which conventional cervical anastomosis was performed, and group 2, in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas in group 2 patients were evaluated using indocyanine and the SPY device (Novadaq Technologies, Inc, Toronto, Ontario, Canada) before and after supercharged cervical anastomosis for esophagectomy. Postesophagectomy complications were also recorded.

Results: The study enrolled 80 patients, which included 62 (77.5%) men, mean age 64.3 years. Groups 1 and 2 comprised 55 patients and 25 patients, respectively. Leakage occurred in 10.5% and 0% of patients in groups 1 and 2, respectively (P = .169), whereas the corresponding anastomotic stricture rates were 14.5% and 4%, respectively (P = .260). Perfusion analyses showed a 26.5% improvement in the anastomotic area after venous anastomosis and a 34.6% improvement after arterial and venous anastomosis.

Conclusions: The supercharged cervical anastomosis for esophagectomy procedure may reduce the occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.

Keywords: SPY; anastomotic leakage; complication; esophagectomy; supercharged.