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Correspondence to Author: M.D. Ph.D.,Naoaki Maeda¹,M.D. Ph.D., Kazuhiro Noma^1*,M.D. Ph.D., Toshiharu Mitsuhashi², M.D. Ph.D., Tomoyoshi Kunitomo¹, M.D., Masashi Hashimoto¹, M.D. Ph.D., Satoru Kikuchi¹,M.D. Ph.D., Toshiaki Ohara^1,3,M.D. Ph.D., Shunsuke Tanabe¹,M.D. Ph.D., Yasuhiro Shirakawa^1,4, M.D. Ph.D., and Toshiyoshi Fujiwara¹. 

¹Department of Gastroenterological Surgery, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
² Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
³Department of Pathology and Experimental Medicine, Okayama University Graduate School of Medicine, Density, and Pharmaceutical Science, Okayama, Japan.
⁴Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

DOI: 10.52338/aots.2025.4481

Abstract:

Background:: Various anastomotic techniques have been developed to reduce postoperative complications. This study aimed to compare the Gambee anastomosis and triangular anastomosis in patients undergoing McKeown esophagectomy for thoracic esophageal cancer.
Methods: We randomly assigned patients to undergo either Gambee anastomosis or triangular anastomosis. The primary endpoint was the incidence of anastomotic leakage. Secondary endpoints included anastomotic stenosis, anastomotic time, and hospital costs.
Results: Seventy-five patients were enrolled between November 2013 and August 2016. Anastomotic leakage (Clavien–Dindo grade ≥II) was significantly less frequent in the Gambee anastomosis group than in the triangular anastomosis group (odds ratio 7.944, 95% confidence interval [CI] 1.648–38.308; p=0.01). The number of dilatations for anastomotic stenosis was significantly lower in the Gambee anastomosis group than in the triangular anastomosis group (incidence rate ratio 3.077, 95%CI 2.064–4.585; p<0.001). Anastomosis time was significantly shorter in the triangular anastomosis group than in the Gambee anastomosis group (coefficient -4.573, 95%CI -7.609– -1.537; p=0.004). Hospital costs showed no significant difference (coefficient 2950.7, 95%CI -4899.362–10,901.26; p=0.462)
Conclusion: The Gambee anastomosis is superior to triangular anastomosis in terms of anastomotic leakage and anastomotic stenosis in cervical esophagogastric anastomosis after McKeown esophagectomy.

Citation:

Dr. M.D. Ph.D., Kazuhiro Noma, Comparison Of End-To-End Gambee Anastomosis And Triangular Anastomosis For Esophagogastric Anastomosis After Subtotal Esophagectomy In Patients With Thoracic Esophageal Cancer: A Prospective Randomized Controlled Trial. Annals of Thoracic Surgery 2025.