Stapled versus hand-sewn anastomosis and anastomotic leaks in gastric cancer surgery – a population-based nationwide study in Finland

Background There is a lack of evidence regarding anastomotic technique and postoperative complications in gastric cancer surgery. The aim of the study was to evaluate whether there are differences between stapled and hand-sewn anastomosis and anastomotic leaks. Methods This was a population based, retrospective, nationwide cohort study in Finland using the Finnish National Esophago-Gastric Cancer Cohort (FINEGO). Gastrectomy patients with available postoperative complication data were included. Logistic regression analysis was used to calculate the odds ratios (OR) with 95% confidence intervals (CI), adjusted for calendar period of surgery, age at surgery, sex, comorbidity, tumor stage, neoadjuvant therapy, minimally invasive surgery, type of gastrectomy, radical resection, and type of anastomosis. Results Of the 2164 patients, 472 (21.8%) of all patients had hand-sewn anastomosis and 1692 (78.2%) of all patients had stapled anastomosis. In the unadjusted analysis, anastomotic leaks were significantly lower in the hand-sewn group (HR 0.42, 95% CI 0.22-0.79) compared to the stapled group, but after adjustment for known prognostic factors, this association was no longer significant (HR 0.57, 95% CI 0.27-1.21). In the analysis stratified by gastrectomy type (distal, or total) no differences in anastomotic leaks were observed between anastomotic techniques. Conclusion In this population-based nationwide study, anastomotic technique (stapled, or hand-sewn) was not associated with anastomotic leaks in any, distal or total, gastrectomy.