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Background: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. Methods: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. Results: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P <.001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P <.001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P =.004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. Conclusions: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit
Kamarajah S. K.;Evans R. P. T.;Nepogodiev D.;Hodson J.;Bundred J. R.;Gockel I.;Gossage J. A.;Isik A.;Kidane B.;Mahendran H. A.;Negoi I.;Okonta K. E.;Sayyed R.;van Hillegersberg R.;Vohra R. S.;Wijnhoven B. P. L.;Singh P.;Griffiths E. A.;Kamarajah S. K.;Hodson J.;Griffiths E. A.;Alderson D.;Bundred J.;Evans R. P. T.;Gossage J.;Griffiths E. A.;Jefferies B.;Kamarajah S. K.;McKay S.;Mohamed I.;Nepogodiev D.;Siaw-Acheampong K.;Singh P.;van Hillegersberg R.;Vohra R.;Wanigasooriya K.;Whitehouse T.;Gjata A.;Moreno J. I.;Takeda F. R.;Kidane B.;Guevara Castro R.;Harustiak T.;Bekele A.;Kechagias A.;Gockel I.;Kennedy A.;Da Roit A.;Bagajevas A.;Azagra J. S.;Mahendran H. A.;Mejia-Fernandez L.;Wijnhoven B. P. L.;El Kafsi J.;Sayyed R. H.;Sousa M.;Sampaio A. S.;Negoi I.;Blanco R.;Wallner B.;Schneider P. M.;Hsu P. K.;Gananadha S.;Wills V.;Devadas M.;Duong C.;Talbot M.;Hii M. W.;Jacobs R.;Andreollo N. A.;Johnston B.;Darling G.;Isaza-Restrepo A.;Rosero G.;Arias-Amezquita F.;Raptis D.;Gaedcke J.;Reim D.;Izbicki J.;Egberts J. H.;Dikinis S.;Kjaer D. W.;Larsen M. H.;Achiam M. P.;Saarnio J.;Theodorou D.;Liakakos T.;Korkolis D. P.;Robb W. B.;Collins C.;Murphy T.;Reynolds J.;Tonini V.;Migliore M.;Bonavina L.;Valmasoni M.;Bardini R.;Weindelmayer J.;Terashima M.;White R. E.;Alghunaim E.;Elhadi M.;Leon-Takahashi A. M.;Medina-Franco H.;Lau P. C.;Okonta K. E.;Heisterkamp J.;Rosman C.;van Hillegersberg R.;Beban G.;Babor R.;Gordon A.;Rossaak J. I.;Pal K. M. I.;Qureshi A. U.;Naqi S. A.;Syed A. A.;Barbosa J.;Vicente C. S.;Leite J.;Freire J.;Casaca R.;Costa R. C. T.;Scurtu R. R.;Mogoanta S. S.;Bolca C.;Constantinoiu S.;Sekhniaidze D.;Bjelovic M.;So J. B. Y.;Gacevski G.;Loureiro C.;Pera M.;Bianchi A.;Moreno Gijon M.;Martin Fernandez J.;Trugeda Carrera M. S.;Vallve-Bernal M.;Citores Pascual M. A.;Elmahi S.;Halldestam I.;Hedberg J.;Monig S.;Gutknecht S.;Tez M.;Guner A.;Tirnaksiz M. B.;Colak E.;Sevinc B.;Hindmarsh A.;Khan I.;Khoo D.;Byrom R.;Gokhale J.;Wilkerson P.;Jain P.;Chan D.;Robertson K.;Iftikhar S.;Skipworth R.;Forshaw M.;Higgs S.;Gossage J.;Nijjar R.;Viswanath Y. K. S.;Turner P.;Dexter S.;Boddy A.;Allum W. H.;Oglesby S.;Cheong E.;Beardsmore D.;Vohra R.;Maynard N.;Berrisford R.;Mercer S.;Puig S.;Melhado R.;Kelty C.;Underwood T.;Dawas K.;Lewis W.;Al-Bahrani A.;Bryce G.;Thomas M.;Arndt A. T.;Palazzo F.;Meguid R. A.;Fergusson J.;Beenen E.;Mosse C.;Salim J.;Cheah S.;Wright T.;Cerdeira M. P.;McQuillan P.;Richardson M.;Liem H.;Spillane J.;Yacob M.;Albadawi F.;Thorpe T.;Dingle A.;Cabalag C.;Loi K.;Fisher O. M.;Ward S.;Read M.;Johnson M.;Bassari R.;Bui H.;Cecconello I.;Sallum R. A. A.;da Rocha J. R. M.;Lopes L. R.;Tercioti V.;Coelho J. D. S.;Ferrer J. A. P.;Buduhan G.;Tan L.;Srinathan S.;Shea P.;Yeung J.;Allison F.;Carroll P.;Vargas-Barato F.;Gonzalez F.;Ortega J.;Nino-Torres L.;Beltran-Garcia T. C.;Castilla L.;Pineda M.;Bastidas A.;Gomez-Mayorga J.;Cortes N.;Cetares C.;Caceres S.;Duarte S.;Pazdro A.;Snajdauf M.;Faltova H.;Sevcikova M.;Mortensen P. B.;Katballe N.;Ingemann T.;Morten B.;Kruhlikava I.;Ainswort A. P.;Stilling N. M.;Eckardt J.;Holm J.;Thorsteinsson M.;Siemsen M.;Brandt B.;Nega B.;Teferra E.;Tizazu A.;Kauppila J. H.;Koivukangas V.;Merilainen S.;Gruetzmann R.;Krautz C.;Weber G.;Golcher H.;Emons G.;Azizian A.;Ebeling M.;Niebisch S.;Kreuser N.;Albanese G.;Hesse J.;Volovnik L.;Boecher U.;Reeh M.;Triantafyllou S.;Schizas D.;Michalinos A.;Balli E.;Mpoura M.;Charalabopoulos A.;Manatakis D. K.;Balalis D.;Bolger J.;Baban C.;Mastrosimone A.;McAnena O.;Quinn A.;O Suilleabhain C. B.;Hennessy M. M.;Ivanovski I.;Khizer H.;Ravi N.;Donlon N.;Cervellera M.;Vaccari S.;Bianchini S.;Sartarelli L.;Asti E.;Bernardi D.;Merigliano S.;Provenzano L.;Scarpa M.;Saadeh L.;Salmaso B.;De Manzoni G.;Giacopuzzi S.;La Mendola R.;De Pasqual C. A.;Tsubosa Y.;Niihara M.;Irino T.;Makuuchi R.;Ishii K.;Mwachiro M.;Fekadu A.;Odera A.;Mwachiro E.;AlShehab D.;Ahmed H. A.;Shebani A. O.;Elhadi A.;Elnagar F. A.;Elnagar H. F.;Makkai-Popa S. T.;Wong L. F.;Tan Y. R.;Thannimalai S.;Ho C. A.;Pang W. S.;Tan J. H.;Basave H. N. L.;Cortes-Gonzalez R.;Lagarde S. M.;van Lanschot J. J. B.;Cords C.;Jansen W. A.;Martijnse I.;Matthijsen R.;Bouwense S.;Klarenbeek B.;Verstegen M.;van Workum F.;Ruurda J. P.;van der Sluis P. C.;de Maat M.;Evenett N.;Johnston P.;Patel R.;MacCormick A.;Young M.;Smith B.;Ekwunife C.;Memon A. H.;Shaikh K.;Wajid A.;Khalil N.;Haris M.;Mirza Z. U.;Qudus S. B. A.;Sarwar M. Z.;Shehzadi A.;Raza A.;Jhanzaib M. H.;Farmanali J.;Zakir Z.;Shakeel O.;Nasir I.;Khattak S.;Baig M.;MA N.;Ahmed H. H.;Naeem A.;Pinho A. C.;da Silva R.;Bernardes A.;Campos J. C.;Matos H.;Braga T.;Monteiro C.;Ramos P.;Cabral F.;Gomes M. P.;Martins P. C.;Correia A. M.;Videira J. F.;Ciuce C.;Drasovean R.;Apostu R.;Ciuce C.;Paitici S.;Racu A. E.;Obleaga C. V.;Beuran M.;Stoica B.;Ciubotaru C.;Negoita V.;Cordos I.;Birla R. D.;Predescu D.;Hoara P. A.;Tomsa R.;Shneider V.;Agasiev M.;Ganjara I.;Gunjic D.;Veselinovic M.;Babic T.;Chin T. S.;Shabbir A.;Kim G.;Crnjac A.;Samo H.;Diez del Val I.;Leturio S.;Ramon J. M.;Dal Cero M.;Rifa S.;Rico M.;Pagan Pomar A.;Martinez Corcoles J. A.;Rodicio Miravalles J. L.;Pais S. A.;Turienzo S. A.;Alvarez L. S.;Campos P. V.;Rendo A. G.;Garcia S. S.;Santos E. P. G.;Martinez E. T.;Fernandez Diaz M. J.;Magadan Alvarez C.;Concepcion Martin V.;Diaz Lopez C.;Rosat Rodrigo A.;Perez Sanchez L. E.;Bailon Cuadrado M.;Tinoco Carrasco C.;Choolani Bhojwani E.;Sanchez D. P.;Ahmed M. E.;Dzhendov T.;Lindberg F.;Rutegard M.;Sundbom M.;Mickael C.;Colucci N.;Schnider A.;Er S.;Kurnaz E.;Turkyilmaz S.;Turkyilmaz A.;Yildirim R.;Baki B. E.;Akkapulu N.;Karahan O.;Damburaci N.;Hardwick R.;Safranek P.;Sujendran V.;Bennett J.;Afzal Z.;Shrotri M.;Chan B.;Exarchou K.;Gilbert T.;Amalesh T.;Mukherjee D.;Mukherjee S.;Wiggins T. H.;Kennedy R.;McCain S.;Harris A.;Dobson G.;Davies N.;Wilson I.;Mayo D.;Bennett D.;Young R.;Manby P.;Blencowe N.;Schiller M.;Byrne B.;Mitton D.;Wong V.;Elshaer A.;Cowen M.;Menon V.;Tan L. C.;McLaughlin E.;Koshy R.;Sharp C.;Brewer H.;Das N.;Cox M.;Al Khyatt W.;Worku D.;Iqbal R.;Walls L.;McGregor R.;Fullarton G.;Macdonald A.;MacKay C.;Craig C.;Dwerryhouse S.;Hornby S.;Jaunoo S.;Wadley M.;Baker C.;Saad M.;Kelly M.;Davies A.;Di Maggio F.;McKay S.;Mistry P.;Singhal R.;Tucker O.;Kapoulas S.;Powell-Brett S.;Davis P.;Bromley G.;Watson L.;Verma R.;Ward J.;Shetty V.;Ball C.;Pursnani K.;Sarela A.;Sue Ling H.;Mehta S.;Hayden J.;To N.;Palser T.;Hunter D.;Supramaniam K.;Butt Z.;Ahmed A.;Kumar S.;Chaudry A.;Moussa O.;Kordzadeh A.;Lorenzi B.;Wilson M.;Patil P.;Noaman I.;Willem J.;Bouras G.;Evans R.;Singh M.;Warrilow H.;Ahmad A.;Tewari N.;Yanni F.;Couch J.;Theophilidou E.;Reilly J. J.;Singh P.;van Boxel Gijs;Akbari K.;Zanotti D.;Sgromo B.;Sanders G.;Wheatley T.;Ariyarathenam A.;Reece-Smith A.;Humphreys L.;Choh C.;Carter N.;Knight B.;Pucher P.;Athanasiou A.;Mohamed I.;Tan B.;Abdulrahman M.;Vickers J.;Akhtar K.;Chaparala R.;Brown R.;Alasmar M. M. A.;Ackroyd R.;Patel K.;Tamhankar A.;Wyman A.;Walker R.;Grace B.;Abbassi N.;Slim N.;Ioannidi L.;Blackshaw G.;Havard T.;Escofet X.;Powell A.;Owera A.;Rashid F.;Jambulingam P.;Padickakudi J.;Ben-Younes H.;Mccormack K.;Makey I. A.;Karush M. K.;Seder C. W.;Liptay M. J.;Chmielewski G.;Rosato E. L.;Berger A. C.;Zheng R.;Okolo E.;Singh A.;Scott C. D.;Weyant M. J.;Mitchell J. D.
2022-01-01
Abstract
Background: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. Methods: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. Results: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P <.001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P <.001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P =.004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. Conclusions: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/627084
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
