Anastomotic Failure Is Not Affected by Anastomotic Technique in Minimally Invasive Two-Stage Oesophagectomy

The choice of anastomotic technique in minimally invasive oesophagectomy (MIO) may influence postoperative morbidity and long-term outcomes. The primary aim of our study is to determine whether circular (CS) or linear-stapled (LS) anastomosis is associated with anastomotic complications following MIO.

A retrospective cohort study was conducted of patients undergoing two-stage MIO with intrathoracic anastomosis for oesophageal cancer between January 2011 and December 2023. The primary outcome was anastomotic leak and stricture formation. Secondary outcomes included postoperative complications and overall survival. Multivariate logistic regression was used to identify independent risk factors for anastomotic leak and stricture.

A total of 245 patients were included: 161 (65.7%) underwent CS and 84 (34.3%) LS anastomosis. The leak rate was higher in the circular group (13.0%) compared to the linear group (8.3%), though not statistically significant (p = 0.271). Leaks in the linear group were more likely to be Grade C (71.1% vs. 28.6%). The incidence of post-operative complications, long-term disease-free survival, and overall survival were comparable. Stricture rates were similar between techniques (17.4% circular vs. 16.6% linear; p = 0.817). On multivariate analysis, active or recent smoking (within 3 months) was independently associated with stricture formation. Ischaemic heart disease was independently associated with anastomotic leak.

Anastomotic technique (circular or linear-stapled) was not associated with an increased risk of anastomotic leak or stricture in patients undergoing MIO with intrathoracic anastomosis. Modifiable patient factors, including recent smoking and ischaemic heart disease, were independent predictors for anastomotic complications.