# Impact of Circular Stapler Size on Short‐Term Outcomes and Long‐Term Quality of Life After McKeown Esophagectomy

## TL;DR

This study found that using a 21mm circular stapler during esophagectomy leads to worse long-term quality of life, particularly with swallowing issues, compared to a 23mm stapler, though short-term outcomes are similar.

## Contribution

The study provides new evidence on the long-term quality of life impact of circular stapler size in esophagectomy patients.

## Key findings

- Short-term outcomes like anastomotic leakage and stenosis were not significantly different between 21mm and 23mm stapler groups.
- Patients with 21mm staplers reported significantly worse meal-related quality of life and dysphagia compared to those with 23mm staplers.
- The study found no significant differences in short-term surgical complications between the two stapler sizes.

## Abstract

The circular stapling technique (CST) is reported to be a simple and time‐efficient method; however, it is associated with a high incidence of anastomotic stenosis for McKeown esophagectomy. Meanwhile, the impact of circular stapler size remains controversial. We aimed to investigate the impact of circular stapler size on both short‐term outcomes and long‐term quality of life (QOL) after McKeown esophagectomy.

In total, 63 consecutive patients who underwent McKeown esophagectomy for esophageal cancer between 2019 and 2022 were eligible. We examined the association between circular stapler size and short‐term outcomes and long‐term QOL using the PGSAS‐37.

35 (55.6%) patients underwent anastomosis with a 21 mm stapler, whereas 28 (44.4%) patients used a 23 mm stapler. No significant differences were observed between the groups. The incidence of anastomotic leakage did not differ significantly between the groups (5.7% vs. 7.1%, p = 1.00) Also, the incidence of anastomotic stenosis did not differ between the groups (25.7% vs. 21.4%, p = 0.77). However, in QOL assessment, the meal‐related subscale (SS) score in the 21 mm group was significantly worse than in the 23 mm group (p = 0.02). Regarding the details the meal‐related SS score, the feeling of dysphagia was significantly worse in the 21 mm group (p < 0.01).

Short‐term outcomes did not differ between patients who underwent anastomosis with a 21 mm stapler and those with a 23 mm stapler, however QOL, particularly the feeling of dysphagia, was worse in patients who used a 21 mm stapler compared to those who used a 23 mm stapler.

In this study, we investigated the impact of circular stapler size on both short‐term outcomes and long‐term QOL after McKeown esophagectomy. We revealed that short‐term outcomes, including anastomotic leakage and stenosis, did not differ between patients who underwent anastomosis with a 21 mm stapler and those with a 23 mm stapler. However, the meal‐related SS score, particularly the feeling of dysphagia, was significantly worse in patients who used a 21 mm stapler compared to those who used a 23 mm stapler.