Gastric Function after Esophagectomy with Vagus Preserved_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HANBing ,  KOUYing-li

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

KOUYing-li, Email: kxyykou@126.com

Keywords：

Vagus nerve; Vagal-sparing esophagectomy; Esophagectomy; Esophageal neoplasms

DOI：

10.7507/1007-4848.20160060

Video：

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Objective To study the gastric function of vagus-preserved patients after esophagectomy, and to evaluate the significance of keeping vagus and the value of gastric tube with vagal-sparing esophagectomy. Methods We retrospectively analyzed clinical data of 15 patients in West China Hospital between June 2012 and January 2014. They were divided into two groups. There were 8 patients with 6 males and 2 females with average age of 57 years ranging from 44 to 77 years, in a gastric pull-up group with vagal-sparing esophagectomy. There were 7 patients with 6 males and 1 female at average age of 60 years ranging from 50 to 70 years in a gastric tube group with vagal-sparing esophagectomy. We chose 8 patients with 7 males and 1 female at average age of 62 years ranging from 47 to 69 years as a control group with a classical esophagectomy and a gastric pull-up. Then we evaluated the function of the vagal nerves and gastric reservoir after vagal-sparing esophagectomy. Results All 23 surgeries were successfully performed. In subjective symptom, diarrhea was rare in the vagal-sparing esophagectomy patients and statistically more common in patients with a standard esophagectomy. Dumping and early satisfaction situation were similar among 3 groups. The 60 minutes gastric emptying rate was much better in the vagal-sparing group than that in the control group. And the esophageal manometry of the vagal-sparing group was statistically hihger than that in the control group. The gastroscope showed that the incidence of reflux esophagitis in the vagal-sparing group was statistically lower than that of the control group. There was no statistic difference in weight in the vagus-preserved group before and after the surgery while the weight decreased statistically in the control group. Conclusions For both esophageal replacement and gastric tube, preserving the vagus can reduce the functional dyspepsia after esophagectomy.

Citation： HANBing, KOUYing-li. Gastric Function after Esophagectomy with Vagus Preserved. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 253-257. doi: 10.7507/1007-4848.20160060 Copy

1.	DeMeester TR, Johansson KE. Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg, 1988, 208(4): 460-474.
2.	Cerfolio RJ, Allen MS, Deschamps C, et al. Esophageal replacement by colon interposition. Ann Thorac Surg, 1995, 59(6): 1382-1384.
3.	Peters JH, Kauer WK, Crookes PF, et al. Esophageal resection with colon interposition for end-stage achalasia. Arch Surg, 1995, 130(6): 632-636.
4.	Watson TJ, DeMeester TR, Kauer WK, et al. Esophageal replacement for end-stage benign esophageal disease. J Thorac Cardiovasc Surg, 1998, 115(6): 1241-1247.
5.	Collard JM, Otte JB, Reynaert M, et al. Quality of life three years or more after esophagectomy for cancer. J Thorac Cardiovasc Surg, 1992, 104(2): 391-394.
6.	Chang AC, Ji H, Birkmeyer NJ, et al. Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg, 2008, 85(2):424-429.
7.	Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterol, 2000, 118(4): 670-677.
8.	Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest endosc, 2007, 65(1): 3-10.
9.	Pouw RE, Gondrie JJ, Sondermeijer CM, et al. Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation, with or without endoscopic resection. J Gastrointest Surg, 2008, 12(10): 1627-1637.
10.	Panjehpour M, Overholt BF, Haydek JM, et al. Results of photody-namic therapy for ablation of dysplasia and early cancer in Barrett's esophagus and effect of oral steroids on stricture formation. Am J Gastroenterol, 2000, 95(9): 2177-2184.
11.	Overholt BF, Panjehpour M. Photodynamic therapy for Barrett's esophagus: Follow-up in 100 patients. Gastrointest Endosc, 1999, 49(1): 1-7.
12.	Akiyama H, Tsurumaru M, Kawamura T, et al. Esophageal stripping with preservation of the vagus nerve. Int surg, 1981, 67(2): 125-128.
13.	Peyre C, DeMeester SR, Rizzetto C, et al. Vagal-sparing esophagec-tomy: the ideal operation for intramucosal adenocarcinoma and Barrett's with high-grade dysplasia. Ann Surg, 2007, 246(4): 665-674.
14.	Banki F, Mason RJ, DeMeester SR, et al. Vagal-sparing esophagec-tomy: a more physiologic alternative. Ann Surg, 2002, 236(3):324-356.
15.	DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol, 2006, 13(1): 12-30.
16.	Oh DS, Hagen JA, Chandrasoma PT, et al. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Amer Coll Surg, 2006, 203(2): 152-161.
17.	Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5): 1805-1813.
18.	De Leyn P, Coosemans W, Lerut T. Early and late functional results in patients with intrathoracic gastric replacement after oesophagec-tomy for carcinoma. Eur J Cardiothorac Surg, 1992, 6(2): 79-84.
19.	Chang EY, Jobe BA. Vagal-Sparing Esophagectomy. Operat Techniq Gen Surg, 2006, 8(3): 136-149.
20.	Shibuya S, Fukudo S, Shineha R, et al. High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy. World J Surg, 2003, 27(6): 580-583.
21.	吴发福, 周刚. 单侧迷走神经支配下胃动力的实验研究. 实用医学杂, 2003, 19(11): 1207-1209.

1. DeMeester TR, Johansson KE. Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg, 1988, 208(4): 460-474.
2. Cerfolio RJ, Allen MS, Deschamps C, et al. Esophageal replacement by colon interposition. Ann Thorac Surg, 1995, 59(6): 1382-1384.
3. Peters JH, Kauer WK, Crookes PF, et al. Esophageal resection with colon interposition for end-stage achalasia. Arch Surg, 1995, 130(6): 632-636.
4. Watson TJ, DeMeester TR, Kauer WK, et al. Esophageal replacement for end-stage benign esophageal disease. J Thorac Cardiovasc Surg, 1998, 115(6): 1241-1247.
5. Collard JM, Otte JB, Reynaert M, et al. Quality of life three years or more after esophagectomy for cancer. J Thorac Cardiovasc Surg, 1992, 104(2): 391-394.
6. Chang AC, Ji H, Birkmeyer NJ, et al. Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg, 2008, 85(2):424-429.
7. Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterol, 2000, 118(4): 670-677.
8. Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer). Gastrointest endosc, 2007, 65(1): 3-10.
9. Pouw RE, Gondrie JJ, Sondermeijer CM, et al. Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation, with or without endoscopic resection. J Gastrointest Surg, 2008, 12(10): 1627-1637.
10. Panjehpour M, Overholt BF, Haydek JM, et al. Results of photody-namic therapy for ablation of dysplasia and early cancer in Barrett's esophagus and effect of oral steroids on stricture formation. Am J Gastroenterol, 2000, 95(9): 2177-2184.
11. Overholt BF, Panjehpour M. Photodynamic therapy for Barrett's esophagus: Follow-up in 100 patients. Gastrointest Endosc, 1999, 49(1): 1-7.
12. Akiyama H, Tsurumaru M, Kawamura T, et al. Esophageal stripping with preservation of the vagus nerve. Int surg, 1981, 67(2): 125-128.
13. Peyre C, DeMeester SR, Rizzetto C, et al. Vagal-sparing esophagec-tomy: the ideal operation for intramucosal adenocarcinoma and Barrett's with high-grade dysplasia. Ann Surg, 2007, 246(4): 665-674.
14. Banki F, Mason RJ, DeMeester SR, et al. Vagal-sparing esophagec-tomy: a more physiologic alternative. Ann Surg, 2002, 236(3):324-356.
15. DeMeester SR. Adenocarcinoma of the esophagus and cardia: a review of the disease and its treatment. Ann Surg Oncol, 2006, 13(1): 12-30.
16. Oh DS, Hagen JA, Chandrasoma PT, et al. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Amer Coll Surg, 2006, 203(2): 152-161.
17. Blackmon SH, Correa AM, Wynn B, et al. Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg, 2007, 83(5): 1805-1813.
18. De Leyn P, Coosemans W, Lerut T. Early and late functional results in patients with intrathoracic gastric replacement after oesophagec-tomy for carcinoma. Eur J Cardiothorac Surg, 1992, 6(2): 79-84.
19. Chang EY, Jobe BA. Vagal-Sparing Esophagectomy. Operat Techniq Gen Surg, 2006, 8(3): 136-149.
20. Shibuya S, Fukudo S, Shineha R, et al. High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy. World J Surg, 2003, 27(6): 580-583.
21. 吴发福, 周刚. 单侧迷走神经支配下胃动力的实验研究. 实用医学杂, 2003, 19(11): 1207-1209.

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