Comparison of double-layered scallop-shaped anastomosis and circular stapled anastomosis in Ivor-Lew surgery - retrospective cohort study

Sep 23, 2026

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Lower esophageal and esophagogastric junction (EGJ) cancers are aggressive and have poor outcomes. Minimally invasive Ivor–Lewis surgery is preferred, yet anastomotic leakage (AL) remains a major complication. This retrospective study introduces double-layered scallop-shaped anastomosis (DLSSA) and compares it with circular stapled esophagogastric anastomosis (CSEA) regarding operative course, postoperative complications, and independent predictors of AL risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Abstract

Background

Methods

Results

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Li etal. BMC Cancer (2025) 25:1035 [https://doi.org/10.1186/s12885-025-14437-w](https://doi.org/10.1186/s12885-025-14437-w) BMC Cancer RESEARCH Open Access Comparison of double-layered scallop-shaped anastomosis and circular stapled anastomosis in Ivor–Lewis surgery for esophageal and EGJ cancer: a retrospective cohort study KunKun Li1, QianYang1, YingJian Wang1, TaiMing Zhang1, Liang Zhang1, Liang Chen1, Tao Bao 1 and Wei Guo1* Abstract Background Cancers ofthe lower esophagus and esophagogastric junction (EGJ) are highly aggressive and have poor prognoses. Minimally invasive Ivor–Lewis surgery (MIIL) is the preferred treatment, but anastomotic leakage (AL) remains a critical complication of this procedure. In the present study, we introduce a novel double-layered scallopshaped anastomosis (DLSSA) technique and compare its outcomes with those of circular stapled esophagogastric anastomosis (CSEA) . Methods From April 2016 to February 2023, 117 patients with distal esophageal or EGJ cancer who underwent complete thoracoscopic–laparoscopic Ivor–Lewis surgery were retrospectively analyzed. Patients were divided into DLSSA (n= 50) and CSEA (n= 67) groups. The median value and ranges are used to present the numerical data. Continuous and categorical variables were compared between groups with the Kruskal‒Wallis test and Fisher’s exact test or χ2 test, respectively. Multivariable binary logistic regression analyses were performed to identify potential prognostic factors. Results The median total operation duration was similar between the groups (280 min) . Intraoperative blood loss was slightly greater in the CSEA group (120 ml vs. 100 ml, p = 0 . 001) . Postoperative complications occurred in 32. 5% of the patients, with no significant between-group difference. However, the incidence of AL was significantly lower (4 . 0% vs. 17. 9%, p = 0 . 022) and that of pleural effusion was significantly greater (10 . 0% vs. 1. 5%, p = 0 . 039) in the DLSSA group than in the CSEA group. Multivariable analysis revealed that a higher body mass index (OR = 1 .453, 95% CI: 1.119–1. 888; p = 0 . 005) was a risk factor for AL, whereas undergoing DLSSA was associated with reduced AL risk (OR = 0 . 052, 95% CI: 0 .005–0. 525; p = 0 . 012), and both variables were considered independent predictors of AL risk. Conclusion Compared with CSEA, DLSSA was associated with significantly lower risk of AL in thoracoscopic Ivor– Lewis surgery, demonstrating its potential as a safer anastomotic technique. However, its association with increased pleural effusion warrants further investigation. Prospective randomized trials are needed to validate long-term outcomes and optimize procedural efficacy. *Correspondence: Wei Guo [gyguowei@hotmail.com](gyguowei@hotmail.com) © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/.)[.](http://creativecommons.org/licenses/by-nc-nd/4.0/.) Li etal. BMC Cancer (2025) 25:1035 Pag

FAQs

What problem does the study address in Ivor–Lewis surgery?

The study focuses on reducing anastomotic leakage (AL), a critical complication after minimally invasive Ivor–Lewis surgery.

How were patients grouped in the retrospective analysis?

Patients (April 2016 to February 2023) who underwent complete thoracoscopic–laparoscopic Ivor–Lewis surgery were divided into DLSSA (n=50) and CSEA (n=67) groups.

What were the main findings regarding anastomotic leakage?

DLSSA showed a significantly lower incidence of AL compared with CSEA (4.0% vs 17.9%). However, pleural effusion incidence was significantly higher in the DLSSA group.

Sep 23, 2026

Uploaded by Fahsai