ArticleEsophagus : official journal of the Japan Esophageal Society2026
Clinical outcomes of 23-mm circular stapled cervical anastomosis after esophagectomy.
Article in Esophagus : official journal of the Japan Esophageal Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeIn 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.
methodsThis 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.
resultsThe 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.
conclusionA 23-mm CS may provide an optimal balance between device size and postoperative complication rates for cervical anastomosis in patients with short remnant esophagus.
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