Current Controversies in Esophagogastric Anastomosis Following Esophagectomy
Keywords:
esophagectomy; esophagogastric anastomosis; anastomotic leak; esophageal surgery; critical reviewAbstract
Introduction: Esophagogastric anastomosis following esophagectomy is a critical procedure that influences postoperative morbidity and mortality, with ongoing controversies regarding the site and technique of anastomosis, leak prevention, and complications.
Objective: To critically analyze the national and international literature on esophagogastric anastomosis by evaluating controversies related to the site, technique, and postoperative complications.
Methods: A review was conducted of articles published through September 2025 in international and Latin American databases. We included clinical trials, reviews, meta-analyses, and case series that evaluated the site and technique of anastomosis, the leakage rate, and complications.
Results: International evidence indicates that intrathoracic anastomosis carries a lower risk of leakage, while cervical anastomosis facilitates the management of complications. The manual technique is safe when basic surgical principles are followed. Cuban series show comparable results, with manageable cervical leaks and acceptable mortality. The incorporation of recovery protocols and minimally invasive surgery improves recovery and reduces complications.
Conclusions: The choice of anastomotic site and technique should be tailored to each individual case, taking into account international evidence, the surgical team’s experience, and local conditions. It is recommended to strengthen local documentation, promote multicenter studies, and progressively implement recovery protocols to optimize surgical outcomes in resource-limited settings.
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