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Page 4 of 11 Kolokotronis et al. Mini-invasive Surg 2021;5:19 https://dx.doi.org/10.20517/2574-1225.2021.07

RESULTS
Patient characteristics, operative data and postoperative outcome
Overall, 126 (71.6%) patients (Group 1) received a hand-sewn anastomosis, while 50 (28.4%) patients
(Group 2) received a stapler anastomosis. Patient characteristics were similar in both groups [Table 1].
Median age of patients at the time of surgery was 61 years (34-88 years), with a male-to-female ratio of
153:23. Fifty-two (29.5%) patients were diagnosed with squamous-cell esophageal cancer, and 124 (70.5%)
patients with esophageal adenocarcinoma. Forty-five (25.6%) patients had chronic obstructive pulmonary
disease (COPD) at the time of surgery, 33 (18.9%) patients coronary heart disease (CHD) and 34 (19.3%)
patients were obese. The preoperative rates of COPD (P = 0.13), CHD (P = 0.20) and obesity (P = 0.42) were
not significantly different between the groups. In total, 93 (52.8%) patients were admitted to neoadjuvant
therapy due to preoperative staging (Group 1: 47.6% vs. Group 2: 66%, P = 0.11).

Median duration of surgery was 269 min (128-532 min), whereas the median intraoperative blood loss was
300 mL (5-4000 mL), as shown in Table 2. The median harvest of dissected lymph nodes was 17 (3-62).

Minor postoperative complications (Clavien-Dindo Grades I-II) were presented in 23 (13%) patients. Major
postoperative complications (Clavien-Dindo Grades III-IV) appeared in 29 (16.5%) patients. Thirteen
(10.3%) patients in Group 1 and 10 (20%) patients in Group 2 suffered from minor complications, whereas
25 (19.8%) patients in Group 1 and 4 (8%) patients in Group 2 suffered from major complications
[Table 2]. More specifically, in Group 1, the distribution of minor complications was as follows: 2 (0.015%)
patients with wound infection, 3 (0.02%) with chyle leak, 3 (0.02%) with pneumonia and 5 (0.04%) with
pleural effusion. In Group 2, the distribution of minor complications was as follows: 1 (0.02%) patient with
wound infection, 1 (0.02%) with chyle leak, 4 (8%) with pneumonia, 6 (0.06%) with pleural effusion and 1
(0.02%) with pneumothorax. The distribution of major complications in Group 1 was as follows: 4 (0.03%)
patients with anastomotic leak, 4 (0.03%) with anastomotic leak and simultaneous gastric conduit necrosis,
5 (0.04%) with anastomotic leak and concomitant mediastinitis, 5 (0.04%) with anastomotic leak and
respiratory insufficiency, 1 (0.008%) patient with bile leak, 1 (0.008%) with early hiatal hernia, 3 (0.02%) with
wound dehiscence and 2 (0.015%) with chyle leak needing reoperation. There were 4 (8%) patients with
anastomotic leak in the stapler anastomosis group. Eighteen (10.2%) patients suffered from lethal
postoperative complication (Clavien-Dindo Grade V) within 90 days after surgery. There were no
significant differences between both groups concerning the incidence of minor and major morbidity,
however the 90-day mortality was higher in the hand-sewn anastomosis group (P = 0.02, Table 2).

Minor surgical complications included wound infection and chyle leak treated conservatively, while minor
cardiopulmonary complications included pleura effusion treated with diuretics, pneumothorax with no
need for draining tube, pneumonia and atrial fibrillation. The minor postoperative morbidity did not differ
significantly between the groups (P = 0.2). Major surgical complications included necrosis of gastric conduit
enterothorax, hiatal hernia, anastomotic leak, wound dehiscence, bile leak (occurring in one patient in the
frame of prophylactic cholecystectomy) and chyle leak with need for reoperation. Surgical complications
(anastomotic leak and necrosis of the gastric conduit) led predominantly to major and lethal postoperative
morbidity (Clavien-Dindo Grades III-V).

Forty-seven (26.7%) patients were subjected to redo surgery during the first hospital stay. The rate of
reoperations differed substantially between both groups (Group 1: 34.1% vs. Group 2: 8%, P = 0.001). The
incidence of anastomotic leak was 12.5% (22/176) and did not differ significantly between the groups
(Group 1: 14.3% vs. Group 2: 8%, P = 0.22), although it was almost 50% reduced in the stapler anastomosis
group. The median hospital stay was 20 days (9-198 days) and did not significantly differ between the