Impact of Preserving Versus Ligating the Right Gastric Artery on Anastomotic Outcomes After McKeown Esophagectomy: A Randomized Controlled Trial

The First Hospital of Hebei Medical University120 enrolled

Overview

This randomized controlled trial evaluates the impact of preserving versus ligating the Right Gastric Artery (RGA) on postoperative anastomotic complications in patients undergoing McKeown minimally invasive esophagectomy (MIE) for esophageal squamous cell carcinoma. Specifically, the study compares the incidence of anastomotic leakage and stenosis between two groups of patients reconstructed with a 3cm-wide gastric conduit.

Anastomotic leakage (AL) and benign anastomotic stenosis (BAS) are critical complications following McKeown MIE. While the right gastroepiploic artery (RGEA) is the primary blood supply for the gastric conduit, the role of the Right Gastric Artery (RGA) remains controversial. Some evidence suggests preserving the RGA may improve perfusion to the proximal gastric conduit, potentially reducing ischemic complications. In this single-center prospective RCT, 120 eligible patients were randomized 1:1 into an RGA Preservation Group (Group A) and an RGA Ligation Group (Group B). Both groups underwent reconstruction with a narrow (3cm) gastric conduit. The study aims to provide evidence on whether RGA preservation improves hemodynamic outcomes as manifested by reduced leakage and stenosis rates.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

120

Conditions

Esophageal Squamous Cell Carcinoma

Interventions

McKeown MIE with RGA PreservationPROCEDURE

Patients in this arm underwent McKeown MIE where the stomach was mobilized while carefully preserving the main trunk of the right gastric artery (RGA). Lymph nodes along the lesser curvature (Station 3) were dissected by peeling them away from the vascular arcade.

McKeown MIE with RGA LigationPROCEDURE

Patients in this arm underwent McKeown MIE where the right gastric artery (RGA) was identified at its origin from the proper hepatic artery and ligated at the root to facilitate en bloc resection of Station 3 lymph nodes.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Histologically confirmed squamous cell carcinoma of the middle or upper thoracic esophagus. * Candidates for elective McKeown minimally invasive esophagectomy (MIE). * Age 18-75 years. * Preoperative clinical stage I-IIIA (cT1-3N0-1M0) according to the AJCC/UICC 8th Edition TNM staging system. Exclusion Criteria: * Clinical stage IIIB or IV. * History of previous thoracic or abdominal surgery affecting the stomach or esophagus. * Neoadjuvant chemoradiotherapy (to eliminate confounding effects on tissue healing). * Severe comorbidities (e.g., uncontrolled diabetes, severe cardiopulmonary dysfunction, liver cirrhosis). * Intraoperative finding of unresectable tumor. * Conversion to open surgery.

Outcomes

Primary Outcomes

Incidence of Cervical Anastomotic Leakage

Defined as the extravasation of contrast on esophagogram or the presence of saliva/gastric content in the cervical wound, often accompanied by fever or inflammatory signs.

Time frame: Up to 30 days postoperatively

Incidence of Anastomotic Stenosis (Early)

Assessment of benign anastomotic stenosis (BAS) via gastroscopy and contrast swallow. Stenosis was graded based on luminal diameter and dysphagia symptoms.

Time frame: 2 months postoperatively

Incidence of Anastomotic Stenosis (Late)

Assessment of benign anastomotic stenosis (BAS) via gastroscopy and contrast swallow. Stenosis was graded based on luminal diameter and dysphagia symptoms.

Time frame: 4 months postoperatively

Secondary Outcomes

Operative Time

The total duration of the surgical procedure measured in minutes.

Time frame: Day 1 (Day of Surgery)

Lymph Node Yield

The total count of lymph nodes harvested during the surgery.