Comparison of Double-Layered Scallop-Shaped Anastomosis and Circular Stapled Anastomosis in Ivor-Lewis Surgery for Egj Cancer: A Retrospective Cohort Study

Background Cancers of the lower esophagus and esophagogastric junction (EGJ) are highly aggressive with poor prognoses. Minimally invasive Ivor–Lewis surgery (MIIL) is preferred, but anastomotic leakage remains a critical complication. This study introduces a novel double-layered scallop-shaped anastomosis (DLSSA) technique and compares its outcomes with circular stapled esophagogastric anastomosis (CSEA). Methods From April 2016 to February 2023, 117 patients with distal esophageal or EGJ cancer undergoing complete thoracoscopic–laparoscopic Ivor–Lewis surgery were retrospectively analyzed. Patients were divided into DLSSA (n = 50) and CSEA (n = 67) groups. The median value and ranges are used to present numerical data. Continuous and categorical variables were compared between groups with the Kruskal-Wallis test and Fisher’s exact test or χ2 test, respectively. Multivariable binary logistic regression analyses were performed to identify potential prognostic factors. Results The median total operation duration was similar between groups (280 minutes). Intraoperative blood loss was slightly higher in the CSEA group (120 mL vs. 100 mL, p = 0.001). Postoperative complications occurred in 32.5% of patients, with no significant difference between groups. However, anastomotic leakage was significantly lower in the DLSSA group (4.0% vs. 17.9%, p = 0.022), while pleural effusion was higher (10.0% vs. 1.5%, p = 0.039). Multivariate analysis identified higher BMI (OR = 1.453, 95% CI:1.119–1.888; p = 0.005) as a risk factor for AL, while DLSSA reduced AL risk (OR = 0.052, 95% CI:0.005–0.525; p = 0.012) as independent predictors of anastomotic leakage. Conclusion DLSSA significantly reduces anastomotic leakage compared to CSEA in thoracoscopic Ivor–Lewis surgery, demonstrating its potential as a safer anastomotic technique. However, its association with increased pleural effusion warrants further investigation. Prospective randomized trials are needed to validate long-term outcomes and optimize procedural efficacy.