Transitioning from hand-sewn to circular stapled cervical anastomosis after minimally invasive esophagectomy: a Western centre propensity score matching analysis

Abstract Cervical esophagogastric anastomosis remains a technically challenging step in esophageal surgery. Hand-sewn techniques have traditionally been favored for their adaptability, while circular stapled anastomosis has gained popularity for its reproducibility and efficiency. However, structured comparative data for cervical anastomosis remain scarce and conflicting. A retrospective monocentric analysis was conducted, based on a prospectively maintained database, on consecutive patients who underwent minimally invasive three-stage esophagectomy (McKeown) with cervical anastomosis for esophageal cancer (January 2018–March 2025). Since February 2022, we have adopted circular stapled cervical anastomosis for all patients, without reverting back. To reduce confounding, propensity score matching was performed using key clinical and oncologic variables. Outcomes of interest included anastomotic leak, anastomotic stricture, postoperative complications, time to oral intake, and hospital length of stay. A total of 127 patients were included, with 36 matched pairs analyzed. The circular stapled group had a lower incidence of anastomotic leak (3/36, 8.3% vs. 7/36, 19.4%) and stricture (6/36, 16.7% vs. 11/36, 30.6%), though differences were not statistically significant. On multivariable analysis, high tumor location was the sole independent predictor of anastomotic leak (OR 3.01, p = 0.023), whereas the circular stapled technique demonstrated a non-significant protective trend (OR 0.56, p = 0.279). Time to resumption of oral intake was significantly shorter in the stapled group (9 vs. 10 days, p = 0.007), and length of hospital stay was reduced (14 vs. 19 days, p < 0.001). Overall complication rates and severity were comparable between groups. The transition from hand-sewn to circular stapled cervical anastomosis was feasible, safe, and associated with improved short-term recovery. Although the mechanical approach does not independently reduce leak rates, its high reproducibility and capacity for technical standardization support its role as a valuable strategy for cervical reconstruction following minimally invasive esophagectomy.