P67 SEMIMECHANICAL ANASTOMOSIS DURING ESOPHAGECTOMY: A NEW GOLD STANDARD?. (23rd November 2019) - Mazza, E
Abstract: Aim: The aim of this single-center retrospective study was to compare the surgical outcomes of semimechanical (SM) and totally manual (TM) anastomoses during esophagectomy regardless of the surgical access and of the type of esophageal replacement. Background and Methods: Several techniques for esophageal anastomosis during esophagectomy have been described, all of which are associated with variable leakage and stricture rates. Given the significant morbidity of esophageal fistula, reducing its incidence is of paramount importance. We report our single-center experience with the semimechanical technique, as compared to the totally manual technique. 312 partial esophagectomies performed between January, 1998 and April, 2018 were analyzed. The series was split into a training period (1/1998-9/2015), when both TM and SM techniques were used, and a validation period (10/2015-4/2018), during which SM technique became standard practice. Propensity score matching was used to reduce confounding. Results: The training period included 212 esophagectomies (90 TM, 122 SM); SM technique was initially used in the neck and afterwards also in the thorax, mainly with gastric conduits (92%), whereas the TM group contained a prevalence of jejunal loops (48%). SM anastomosis was associated with a significant reduction of both fistula (0.8% versus 12.2%; p<0.001) and stricture rate (0% versus 6.7%; p=0.005). After propensity score matching the difference in fistula (0% versus 13.5%; p=0.013) and stricture rate (0% versus 9.6%; p=0.022) was confirmed. During the validation period, which included 100 esophagectomies performed with SM anastomosis, 1 fistula (1%) and 1 stricture (1%) were observed. Conclusions: SM technique for esophageal anastomosis outperforms TM technique and allows achieving very low complications rates.