A new oblique-to-side esophagogastric anastomosis approach reduces the incidence of postoperative anastomotic leak after esophagectomy for esophageal carcinoma: a propensity score-matched retrospective study

Anastomotic leakage is one of the most severe postoperative complications following esophagectomy for esophageal carcinoma. This study compared the incidence of postoperative anastomotic leakage after esophagectomy between a novel oblique-to-side esophagogastric anastomosis and the conventional end-to-side esophagogastric anastomosis. Clinical data from 318 patients with esophageal carcinoma (106 cases treated with the new anastomosis and 212 with the conventional approach) who underwent radical esophagectomy between January 2018 and November 2021 were retrospectively collected. Propensity score matching (PSM) was applied to balance baseline characteristics, yielding 188 matched patients (94 in each group). The primary outcome was the incidence of anastomotic leakage, while secondary outcomes included anastomotic stenosis, incisional infection, and pulmonary, cardiovascular, and digestive complications. After PSM, the new anastomosis group showed a significantly lower incidence of anastomotic leakage than the conventional group (6.4% vs. 22.3%, <i>P</i>=0.002). Besides, the incidence of postoperative fever was lower in the new anastomosis (10.6% vs. 27.7%, <i>P</i>=0.003). No significant differences were observed between the groups regarding anastomotic stenosis, incisional infection, or other systemic complications. Multivariate analysis identified the new oblique-to-side esophagogastric anastomosis as an independent protective factor against leak (OR=0.294, P=0.020). In conclusion, the oblique-to-side anastomosis effectively reduces postoperative anastomotic leak after radical esophagectomy without increasing other postoperative complications, demonstrating both safety and clinical efficacy.