Low Anastomotic Leakage After Esophagectomy Using a Standardized Narrow Gastric Conduit Reconstruction Protocol

Background Anastomotic leakage remains one of the most serious complications after esophagectomy and is associated with increased morbidity, mortality, and impaired long-term outcomes. Although various technical modifications have been proposed to reduce leakage, the potential role of standardizing the entire reconstructive procedure has received less attention. We evaluated outcomes after a standardized reconstruction protocol using a narrow gastric conduit and triangular stapled cervical esophagogastrostomy. Methods We retrospectively reviewed 115 consecutive patients who underwent subtotal esophagectomy followed by gastric conduit reconstruction with cervical anastomosis at 2 institutions between March 2018 and November 2024. The standardized protocol emphasized preservation of a well-perfused conduit segment, optimization of the reconstruction route, and triangular stapled cervical esophagogastrostomy. Anastomotic leakage was defined and classified according to the Esophagectomy Complications Consensus Group (ECCG) criteria. Results Anastomotic leakage was identified in 2 patients (1.7%; exact 95% confidence interval, 0.2%–6.1%), both classified as ECCG Type II. No Type III leaks occurred. Anastomotic stricture developed in 10 patients (8.7%), recurrent laryngeal nerve palsy in 12 (10.4%), and Clavien–Dindo grade IIIa or higher complications in 21 (18.3%). Thirty-day and 90-day mortality were 1.7% and 2.6%, respectively, with no deaths related to anastomotic leakage. Discussion A standardized narrow gastric conduit reconstruction protocol was associated with a low observed rate of clinically identified anastomotic leakage. Because of the retrospective design, small number of events, and absence of a contemporaneous control group, superiority over historical benchmarks cannot be established.