Despite a wider application of robot to radical esophageal resection in recent years, the process of esophagogastrostomy is relatively complicated. Current commonly-applied clinical techniques in digestive tract reconstruction include end-to-end anastomosis, end-to-side anastomosis, and side-side anastomosis. The main methods are divided into manual and mechanical anastomosis. And the main instruments applied include circular stapler and linear stapler. Different technologies vary in advantages and restrictions and selecting the technique in esophageal operation depends on the situation of the tumor and the operator’s preference. The improved anastomosis techniques and the updated anastomosis instruments effectively lower the incidence of complications after esophagogastrostomy. However, there are still great difficulties in carrying out a safe and efficient reconstruction of the digestive tract during the operation. Scholars over the world have been working hard on it and have made modified various reconstruction techniques. Different technologies vary in advantages and restrictions and the choice of the technique depends on the situation of the tumor and the patient’s preference. There is no unified consensus on the choice of the technique. This paper introduces the research progress in robot’s assisted esophagogastrostomy from two aspects including the technique and method of anastomosis.
Objective To analyze the influencing factors for postoperative anastomotic leak (AL) in carcinoma of the esophagus and gastroesophageal junction and construct a nomogram predictive model. Methods The patients who underwent radical esophagectomy at Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were included in this study. Relevant variables were screened using univariate and multivariate logistic regression analyses. A nomogram was then developed to predict the risk factors associated with postoperative AL. The predictive performance of the nomogram was validated using the receiver operating characteristic (ROC) curve. Results A total of 468 patients with carcinoma of the esophagus and gastroesophageal junction were included in the study, comprising 354 males and 114 females, with a mean age of (62.8±7.2) years. The tumors were predominantly located in the middle or lower esophagus, and 51 (10.90%) patients experienced postoperative AL. Univariate logistic regression analysis indicated that age, body mass index (BMI), tumor location, preoperative albumin levels, diabetes mellitus, anastomosis technique, anastomosis site, and C-reactive protein (CRP) levels were potentially associated with AL (P<0.05). Multivariate logistic regression analysis identified age, BMI, tumor location, diabetes mellitus, anastomosis technique, and CRP levels as independent risk factors for AL (P<0.05). A nomogram was developed based on the findings from the multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was 0.803, indicating a strong concordance between the actual observations and the predicted outcomes. Furthermore, decision curve analysis demonstrated that the newly established nomogram holds significant value for clinical decision-making. Conclusion The predictive model for postoperative AL in patients with carcinoma of the esophagus and gastroesophageal junction demonstrates strong predictive validity and is essential for guiding clinical monitoring, early detection, and preventive strategies.