Circular vs. linear stapling after minimally invasive and robotic-assisted esophagectomy: a pooled analysis

Area of Science:

• Gastrointestinal Surgery
• Thoracic Surgery
• Surgical Oncology

Background:

• Minimally invasive esophagectomy (MIE) and robotic-assisted minimally invasive esophagectomy (RAMIE) are increasingly utilized for esophageal cancer treatment.
• Previous studies suggest potential differences in postoperative complications between linear and circular stapling in open esophagectomy.
• A comprehensive overview for minimally invasive approaches is lacking.

Purpose of the Study:

• To compare postoperative complication rates associated with linear stapling (LS) versus circular stapling (CS) in minimally invasive esophagectomy (MIE) and robotic-assisted minimally invasive esophagectomy (RAMIE).
• To evaluate differences in anastomotic leakage, pulmonary complications, and hospital stay between the two stapling techniques.

Main Methods:

• A pooled analysis of 4 relevant publications comparing LS and CS in MIE and RAMIE.
• Primary endpoints included anastomotic leakage, pulmonary complications, and mean hospital stay.
• Consideration of learning curves was noted as a limitation in some included studies.

Main Results:

• No statistically significant difference was found in anastomotic insufficiency between LS and CS (p=0.34).
• Postoperative pulmonary complications were similar for both stapling techniques.
• No trend favoring either CS or LS was identified (p=0.82).
• Data on postoperative anastomotic stricture was insufficient for analysis.

Conclusions:

• Current evidence is insufficient to recommend a specific mechanical stapling technique for MIE or RAMIE.
• Further randomized controlled trials (RCTs) are required to elucidate potential differences between LS and CS.
• Standardizing a single anastomotic technique per center and focusing on surgeon learning curves are suggested to minimize complications.