Comparison of Double-Layered Scallop-Shaped Anastomosis and Circular Stapled Anastomosis in Ivor-Lewis Surgery for Esophageal and EGJ Cancer: A Retrospective Cohort Study

Background: Cancers of the lower esophagus and esophagogastric junction (EGJ) are highly aggressive with poor prognoses. Minimally invasive Ivor–Lewis surgery (MIIL) is preferred, but anastomotic leakage remains a critical complication. This study introduces a novel double-layered scallop-shaped anastomosis (DLSSA) technique and compares its outcomes with circular stapled esophagogastric anastomosis (CSEA). Methods: From April 2016 to February 2023, 117 patients with distal esophageal or EGJ cancer undergoing 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 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 groups (280 minutes). Intraoperative blood loss was slightly higher in the CSEA group (120 ml vs. 100 ml, p=0.001). Postoperative complications occurred in 32.5% of patients, with no significant difference between groups. However, anastomotic leakage was significantly lower in the DLSSA group (4.0% vs. 17.9%, p=0.022), while pleural effusion was higher (10.0% vs. 1.5%, p=0.039). Multivariate analysis identified higher BMI (OR=1.453, 95% CI:1.119–1.888; p=0.005) as a risk factor for AL, while DLSSA reduced AL risk (OR=0.052, 95% CI:0.005–0.525; p=0.012) as independent predictors of anastomotic leakage. Conclusion: DLSSA significantly reduces anastomotic leakage compared to CSEA 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.