Modified Collard technique outperforms CS technique in reducing incidence of anastomotic stricture

The Modified Collard (MC) technique was found to outperform the circular stapled (CS) technique in reducing the incidence of anastomotic stricture and improving the postoperative quality of life as per a study that was published in the journal Annals of Surgery.  

There are significant risks of anastomotic complications after esophagectomy with the presently used techniques of anastomosis. Despite the various techniques, the optimal anastomotic technique after esophagectomy has not yet been established. Hence researchers from Japan conducted a study to investigate the efficacy of the modified Collard (MC) technique for reducing anastomotic stricture after esophagectomy compared with the circular stapled (CS) technique. 

Participants were randomly allocated to either the CS group or the MC group. The primary endpoint was the incidence of anastomotic stricture. The secondary endpoints included the incidence of postoperative complications including anastomotic leakage and quality of life (QoL). All anastomoses were performed after indocyanine green evaluation for objective homogenization of blood flow to the gastric conduit between the 2 techniques. 

Key findings: 

• 100 patients were randomized of which the CS group had 50 and the MC group had 50. 
• No patients in the MC group reported anastomotic strictures but in the CS group, it was observed in 18 patients.
• There were no significant group differences in anastomotic leakage (CS group, 7% vs MC group, 8%; P = 0.94).
• MC group patients reported significantly better Quality of life domains of dysphagia and choking when swallowing 3 months after surgery than the CS group.

Thus, the researchers concluded that the MC technique is better in decreasing the incidence of anastomotic stricture and improving the postoperative quality of life. Based on the accurate comparison under objective homogenization of the gastric conduit condition, they also found that the incidence of anastomotic leakage is comparable between the 2 techniques.  

For full reading, click here: 10.1097/SLA.0000000000005185 

Hosoi T, Abe T, Higaki E, et al. Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy: A Randomized Controlled Trial. Ann Surg. 2022;276(1):30-37.