Clinical outcomes of 23-mm circular stapled cervical anastomosis after esophagectomy

In cervical esophagogastric anastomosis following esophagectomy with a short residual esophagus, available anastomotic options are limited. Circular staplers (CSs) of various diameters are frequently used; however, the optimal size for minimizing postoperative complications remains unclear. We evaluated whether the newly introduced 23-mm CS reduces the incidence of anastomotic leakage and stricture compared with conventional sizes.

This retrospective study analyzed 278 patients who underwent esophagectomy followed by cervical esophagogastric anastomosis using a CS between 2013 and 2021. After the introduction of the 23-mm CS, it replaced the 25-mm CS as the preferred device. A 21-mm CS was reserved for cases in which the use of a 23-mm or 25-mm CS was unfeasible. Postoperative anastomotic leakage and stricture rates were compared according to CS diameter.

The 23-mm CS was associated with significantly less anastomotic leakage than the 25-mm CS (4% vs. 15%; P = 0.025). The incidence of anastomotic stricture was significantly lower in the 23-mm CS than that in the 21-mm CS (27% vs. 59%; P < 0.001), although the rates were comparable between the 23- and 25-mm CS groups. Anastomotic leakage was strongly associated with subsequent stricture development, particularly in the 21-mm CS group. Multivariate analysis identified the use of a 21-mm CS and leakage as independent risk factors for postoperative stricture.

A 23-mm CS may provide an optimal balance between device size and postoperative complication rates for cervical anastomosis in patients with short remnant esophagus.