Clinical efficacy of end-to-end anastomosis followed by mucosal folding and burying in minimally invasive esophageal cancer surgery

Abstract

Background: Esophageal cancer is a common malignancy in China, with anastomotic fistula being a major postoperative complication. This study compares the clinical outcomes of end-to-end anastomosis and end-to-end anastomosis with mucosal folding and burying in minimally invasive esophageal cancer surgery.

Methods: From October 2020 to March 2023, patients with esophageal cancer who underwent laparoscopic three-incision cervical anastomosis at the Fourth People's Hospital of Zigong City, were radomly assigned to receive either end-to-end anastomosis or end-to-end anastomosis followed by mucosal folding and burying. Clinical indicators, including hospitalization time, operation time, intraoperative blood loss, anastomotic fistula, and anastomotic stenosis, were compared between the two groups.

Results: A total of 107 patients werencluded, with 56 in the end-to-end anastomosis with mucosal folding and burying technique group. There were no statistically significant differences between the two groups in operation time, intraoperative blood loss, anastomotic fistula rate, and anastomotic stenosis. However, for patients who received preoperative chemoradiotherapy or chemotherapy combined with immunotherapy, the incidence of anastomotic fistula was significantly lower in the group with end-to-end anastomosis with mucosal folding and burying.

Conclusions: End-to-end anastomosis followed by mucosal folding and burying helps reduce the occurrence of anastomotic fistula, especially in patients receiving neoadjuvant chemoradiotherapy.

Keywords: Minimally invasive esophageal cancer surgery; cervical anastomosis; conical tubular stomach; end-to-end anastomosis with mucosal folding and burying.