610. CROSS-BEDDED ANTI-REFLUX ANASTOMOSIS ACHIEVED LESS GASTROESOPHAGEAL REFLUX WITHOUT ADDITIONAL DYSPHAGIA COMPARED TO CONDITIONAL ANASTOMOSIS IN MCKEOWN ESOPHAGECTOMY

Abstract Background Most esophageal cancer patients undergoing Mckeown esophagectomy had severe postoperative gastroesophageal reflux and poor quality of life. A novel anastomosis technique was invented to improve this situation. We conducted this study to investigate the incidence of gastroesophageal reflux, dysphagia, and quality of life (QoL) among patients with esophageal cancer undergoing non-intussuscepted anastomosis and cross-bedded anti-reflux (CAR) anastomosis during Mckeown esophagectomy. Methods Data from patients who underwent Mckeown esophagectomy for esophageal cancer from March 2022 to December 2022 were retrospectively analyzed. The incidence of gastroesophageal reflux, dysphagia, and QoL were measured. We enrolled 218 patients, including 155 patients undergoing non-intussuscepted anastomosis and 63 patients undergoing CAR anastomosis. Propensity score matching was used to provide a balanced cohort consisting of 63 paired cases. Patients’ demographics and clinical data were compared between the two arms. Results Before propensity score matching, there were no significant differences between the two arms in terms of sex, age, body mass index, or comorbidities. Neoadjuvant therapy was the only unbalanced variable. After propensity matching, baseline characteristics were all comparable between them. Anastomotic leakage occurred in 1 (1.6%) patient in the CAR anastomosis arm and in 2 (3.2%) in the non-intussuscepted anastomosis arm. No significant difference was observed in dysphagia severity (P=0.267). 45 (71.4%) patients in the non-intussuscepted anastomosis arm and 60 (95.2%) in the CAR anastomosis arm slept in the supine position (P=0.001). Gastroesophageal reflux was milder in the CAR anastomosis arm (P<0.001). The CAR anastomosis arm was superior to the non-intussuscepted anastomosis arm in the social functioning domain (P=0.004) and financial difficulties domain (P=0.026) of QoL. Conclusions CAR anastomosis achieved sufficient control of gastroesophageal reflux without causing dysphagia. It also improved QoL compared with non-intussuscepted anastomosis. https://1drv.ms/v/s!AmCqlJJZqDPDjRcLYFEgRSPHrUDY?e=1bEAyy