Guoqing Zhang, Kanghua Zhang, Yan Zhang, Teng Mu, Ziyou Tao, Jia Jiao, Long Qiu, Xue Pan, Jia Zhao, Xiangnan Li
Among 573 patients (102 Y-shaped, 471 O-shaped), the Y-shaped group was older (66.1 vs 63.0 years; P < .001), had more cN3 disease (P = .006), and had better tumor differentiation (P = .006). Anastomotic leakage (1.0% vs 5.9%; P = .038), stricture (3.9% vs 12.3%; P = .013), dysphagia (4.9% vs 16.8%; P = .002), and symptomatic reflux (8.8% vs 23.1%; P = .001) were significantly lower in the Y-shaped group. Postoperative hospital stay was shorter in the Y-shaped group (11.8 ± 2.98 vs 13.2 ± 7.96 days; P = .003). At 6 months, mean dysphagia scores (14.33 vs 20.92; P < .001) and reflux scores (21.01 vs 31.86; P < .001) on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Esophageal Cancer Module 18 were significantly lower in the Y-shaped group. The distribution of complication severity according to the Clavien-Dindo classification was comparable between groups (P = .636).
BACKGROUND: Anastomotic complications, including anastomotic leakage, stricture, and reflux, remain major sources of morbidity after esophagectomy, yet existing techniques inadequately address this triad of issues.
OBJECTIVE: To describe a novel Y-shaped layered antireflux anastomosis (Y-shaped group) and evaluate its preliminary outcomes compared with conventional circular-stapled anastomosis (O-shaped group).
DESIGN: Retrospective review of a prospectively maintained database from a tertiary referral center, including consecutive patients who underwent thoracolaparoscopic esophagectomy with gastric tube reconstruction between January and December 2025.
INTERVENTIONS: Hand-sewn Y-shaped anastomosis versus circular-stapled end-to-side anastomosis.
RESULTS: Among 573 patients (102 Y-shaped, 471 O-shaped), the Y-shaped group was older (66.1 vs 63.0 years; P < .001), had more cN3 disease (P = .006), and had better tumor differentiation (P = .006). Anastomotic leakage (1.0% vs 5.9%; P = .038), stricture (3.9% vs 12.3%; P = .013), dysphagia (4.9% vs 16.8%; P = .002), and symptomatic reflux (8.8% vs 23.1%; P = .001) were significantly lower in the Y-shaped group. Postoperative hospital stay was shorter in the Y-shaped group (11.8 ± 2.98 vs 13.2 ± 7.96 days; P = .003). At 6 months, mean dysphagia scores (14.33 vs 20.92; P < .001) and reflux scores (21.01 vs 31.86; P < .001) on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Esophageal Cancer Module 18 were significantly lower in the Y-shaped group. The distribution of complication severity according to the Clavien-Dindo classification was comparable between groups (P = .636).
CONCLUSION AND RELEVANCE: The Y-shaped anastomosis was technically feasible and associated with lower rates of leakage, stricture, dysphagia, and reflux. These findings warrant prospective validation.