Summary Cervical anastomotic stenosis remains a common complication following totally minimally invasive McKeown esophagectomy. The role of the right gastric artery in gastric conduit perfusion is debated, especially with narrow-tube reconstructions. This study aimed to evaluate the impact of RGA preservation versus ligation on anastomotic outcomes. In a single-center randomized controlled trial, 120 patients undergoing totally laparoscopic and thoracoscopic McKeown esophagectomy for esophageal squamous cell carcinoma were assigned to RGA preservation (n = 60) or ligation (n = 60). All procedures utilized a standardized 3-cm-wide gastric conduit. The RGA was preserved laparoscopically by skeletonizing its trunk along the lesser curvature. Sample size was calculated based on the primary endpoint of anastomotic stenosis incidence. The primary endpoint was the anastomotic stenosis rate at 2 and 4 months, while the secondary endpoint was the anastomotic leakage rate. At 2 months postoperatively, stenosis was significantly lower in the preservation group (30.0% vs. 60.0%, P 0.05). The mean number of endoscopic dilation sessions was significantly lower in the preservation group (1.5 ± 0.6) compared to the ligation group (2.8 ± 1.1) (P 0.05). By 4 months, stenosis rates decreased to 10.0% and 18.3%, respectively (P = 0.152). As a secondary endpoint, anastomotic leakage occurred in 10.0% of the preservation group versus 16.7% in the ligation group (P = 0.283). Lymph node harvest was comparable between groups, and no conversion to open surgery occurred. Laparoscopic preservation of the right gastric artery during totally minimally invasive McKeown esophagectomy significantly reduces early anastomotic stenosis without compromising lymphadenectomy. This technique represents a safe and feasible modification in narrow-conduit reconstruction, with potential benefits for functional recovery and postoperative quality of life in the early postoperative period.
Zhang et al. (Thu,) studied this question.