Impact of a long linear staplers on the incidence of stricture after triangulating esophagogastric anastomosis

Background: Various techniques have been reported for esophagogastric anastomosis to prevent anastomotic leakage. Recently, not only postoperative anastomotic leakage but also anastomotic stricture is considered important because stricture contributes to the patient's postoperative quality of life. However, the best procedure for anastomosis has not been established. Materials and Methods: The authors divided 101 patients with thoracic or abdominal esophageal cancer who underwent cervical triangulating esophagogastric anastomosis using a linear stapler between May 2017 and May 2020 into 2 groups: surgery with a short (45 mm) linear stapler (SS group, n = 59) or a long (60 mm) stapler (LS group, n = 42). The frequencies of anastomotic leakage and stricture were compared between the 2 groups. Results: The incidence of anastomotic leakage and stricture without leakage were significantly lower in the LS versus SS group (respectively: leakage: 15% vs. 0%, P = 0.01; stricture: 36% vs. 7%, P = 0.01). A short linear stapler and anastomotic leakage were independent risk factors for anastomotic stricture in the multivariate analysis (short stapler: odds ratio, 3.27; 95% confidence interval, 1.08-9.9; P = 0.03; anastomotic leakage: odds ratio, 2.78; 95% confidence interval, 1.02-8.5; P = 0.04). Conclusion: A long linear stapler is preferable for cervical triangulating esophagogastric anastomosis.