The comparison of manual and mechanical anastomosis after total pharyngolaryngoesophagectomy

Kexi Wang; Xiaotian He; Duoguang Wu; Kefeng Wang; Yuquan Li; Wenjian Wang; Xueting Hu; Kai Lei; Binghua Tan; Ruihao Liang; Qian Cai; Minghui Wang

doi:10.3389/fonc.2023.1041396

The comparison of manual and mechanical anastomosis after total pharyngolaryngoesophagectomy

Front Oncol. 2023 Feb 27:13:1041396. doi: 10.3389/fonc.2023.1041396. eCollection 2023.

Authors

Kexi Wang^{1

2}, Xiaotian He^{1

2}, Duoguang Wu^{1

2}, Kefeng Wang^{1

2}, Yuquan Li^{1

2}, Wenjian Wang^{1

2}, Xueting Hu^{1

2}, Kai Lei^{1

2}, Binghua Tan^{1

2}, Ruihao Liang^{1

2}, Qian Cai^{2

3}, Minghui Wang^{1

2}

Affiliations

¹ Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
³ Department of Otolaryngology Surgery, Sun Yat-sen Memorial Hospital, Guangzhou, China.

Abstract

Background: Total pharyngolaryngoesophagectomy (TPLE) is considered as a curative treatment for hypopharynx cancer and cervical esophageal carcinomas (HPCECs). Traditional pharyngo-gastric anastomosis is usually performed manually, and postoperative complications are common. The aim of this study was to introduce a new technique for mechanical anastomosis and to evaluate perioperative outcomes and prognosis.

Methods: From May 1995 to Nov 2021, a series of 75 consecutive patients who received TPLE for a pathological diagnosis of HPCECs at Sun Yat-sen Memorial Hospital were evaluated. Mechanical anastomosis was performed in 28 cases and manual anastomosis was performed in 47 cases. The data from these patients were retrospectively analyzed.

Results: The mean age was 57.6 years, and 20% of the patients were female. The rate of anastomotic fistula and wound infection in the mechanical group were significantly lower than that in the manual group. The operation time, intraoperative blood loss and postoperative hospital stays were significantly higher in the manual group than that in the mechanical group. The R0 resection rate and the tumor characteristics were not significantly different between groups. There was no significant difference in overall survival and disease-free survival between the two groups.

Conclusion: The mechanical anastomosis technology adopted by this study was shown to be a safer and more effective procedure with similar survival comparable to that of manual anastomosis for the HPCECs patients.

Keywords: anastomosis; manual; mechanical; postoperative complications; total pharyngolaryngoesophagectomy.

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81871886, 81672415), the Guangzhou Science and Technology Project (No. 202103000063) and the Basic and applied basic research fund of Guangzhou basic research program (No. 202201011562).