Intrathoracic vs Cervical Anastomosis after Esophagectomy fo
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In this JAMA Surgery study, researchers found that intrathoracic anastomosis resulted in a better outcome for patients treated with transthoracic minimally invasive esophagectomy for midesophageal to distal esophageal or gastroesophageal junction cancer.

Transthoracic minimally invasive esophagectomy (MIE) is increasingly performed as part of curative multimodality treatment. The aim of this study was to compare an intrathoracic with a cervical anastomosis in a randomized clinical trial.

This open, multicenter randomized clinical superiority trial was performed at 9 Dutch high-volume hospitals. Patients with midesophageal to distal esophageal or gastroesophageal junction cancer planned for curative resection were included. Two hundred sixty-two patients were randomized, and 245 were eligible for analysis.

Anastomotic leakage necessitating reintervention occurred in 15 of 122 patients with intrathoracic anastomosis and in 39 of 123 patients with cervical anastomosis.

--Overall anastomotic leak rate was 12.3% in the intrathoracic anastomosis group and 34.1% in the cervical anastomosis group.

--Intensive care unit length of stay, mortality rates, and overall quality of life were comparable between groups, but intrathoracic anastomosis was associated with fewer severe complications, and better quality of life in 3 subdomains (mean differences: dysphagia, -12.2; problems of choking when swallowing, -10.3; trouble with talking, -15.3).

In summary, intrathoracic anastomosis resulted in a better outcome for patients treated with transthoracic MIE for midesophageal to distal esophageal or gastroesophageal junction cancer.

Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2779968
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