Application of Pleural Tenting in Ivor-Lewis Esophagogastrectomy: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HEXiao-feng , XUWang-zi ,  CAOBin

Department of Thoracic-Cardio Surgery, Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing 210008, P. R. China;

Corresponding author：

CAOBin, Email: Njglcb2001@163.com

Keywords：

Pleural tenting; Esophageal cancer; Quality of life; Anastomotic leak

DOI：

10.7507/1007-4848.20160243

Video：

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Objective To explore the superiority of pleural tenting in Ivor-Lewis esophagogastrectomy. Methods We prospectively included 200 esophagus cancer patients with Ivor-Lewis esophagogastrectomy in our hospital between 2013 and 2015 year. The patients were allocated into two groups including a trial group and a control group with 100 patients in each group. There were 72 males and 28 females at an average age of 54.76±6.62 years in the trial group and 66 males and 34 females at an average age of 55.72±6.38 years in the control group. In the trial group pleural tenting was used to cover the anastomotic stoma and gastric tube, while in the control group pleural tenting was not used. Postoperative complications after one year, pressure on the level of the anastomotic stoma, and the grade of quality of life were compared between the two groups. Result No statistically significant differences were found in preoperative epidemiological and postoperative pathological characteristics, as well as the postoperative complications and the one-year survival rate (P > 0.05). Quality of life was better in the trial group than that of the control group. Conclusion Pleural tenting is a simple, safe, and effective technique for improving quality of life of the patients.

Citation： HEXiao-feng, XUWang-zi, CAOBin. Application of Pleural Tenting in Ivor-Lewis Esophagogastrectomy: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1029-1033. doi: 10.7507/1007-4848.20160243 Copy

1.	Zhang H, Wang J, Wang W, et al. A meta-analysis of esophagec-tomy: the comparative study of Ivor-Lewis operation and Sweet operation. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 892-897.
2.	冒志明, 顾晓华, 李昌炎, 等. Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的前瞻性研究.中华消化外科杂志, 2013, 12(10): 754-758.
3.	Lin J, Kang M, Lin J, et al. Short-term efficacy comparison between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 888-891.
4.	Uzzaman MM, Daniel RJ, Mhandu PC, et al. A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy. Ann Thorac Surg, 2014, 97(1): 365-372.
5.	Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis, 2014, 6(3): 271-284.
6.	郭予雄, 何少茹, 钟敏泉, 等.小儿先天性心脏病术后乳糜胸的诊断和治疗.中国胸心血管外科临床杂志, 2015, 22(8): 734-738.
7.	Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
8.	Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesopha-gogastric anastomosis: single-centre analysis of 415 oesophagec-tomies. Eur J Cardiothorac Surg, 2016, 49(6): 1650-1659.
9.	孙振宇, 顾敏威, 赵永, 等.食管贲门癌术后胸内吻合口狭窄的临床分析.南京医科大学学报(自然科学版), 2010, 30(8): 1211-1213.
10.	De Giacomo T, Francioni F, Venuta F, et al. Complete mechanical cervical anastomosis using a narrow gastric tube after esophagec-tomy for cancer. Eur J Cardiothorac Surg, 2004, 26(5): 881-884.
11.	Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psycho-metric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
12.	杨国明, 王会志, 董驹, 等.贲门癌、食管癌切除术后食管-胃肌瓣胃腔内瓣膜式吻合术的测压观察.河北医科大学学报, 2011, 32(6): 699-700.
13.	王文凭, 陈龙奇.食管癌外科治疗的现状与展望.中国胸心血管外科临床杂志, 2011, 18(1): 58-65.
14.	Li B, Xiang J, Zhang Y, et al. Factors affecting hospital mortality in patients with esophagogastric anastomotic leak: a retrospective study. World J Surg, 2016, 40(5): 1152-1157.
15.	段红兵, 李敏杰, 康健乐.管状胃成形对预防食管癌切除术后胃食管反流的作用.中国胸心血管外科临床杂志, 2010, 17(5): 417-419.
16.	臧其威, 郑中锋, 陈伟.食管胃高位胸顶吻合加纵膈胸膜减张覆盖在食管癌手术中的应用.齐齐哈尔医学院学报, 2010, 31(5): 708-709.
17.	Asteriou C, Barbetakis N, Lalountas M, et al. Modified pleural tenting for prevention of anastomotic leak after ivor lewis esopha-gogastrectomy. Ann Surg Oncol, 2011, 18(13): 3737-3742.
18.	姜志良, 杨继武, 王林, 等.经食管床吻合术后对残余食管的压力测定和酸碱度分析.中华胃肠外科杂志, 2008, 11(1): 32-35.
19.	赵雍凡, 王资斌, 伍伫, 等.不同平面胃食管吻合术后食管腔内24小时pH监测.中国胸心血管外科临床杂志, 1998, 5(3): 19-20.
20.	Honda M, Wakita T, Onishi Y, et al. development and validation of a disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer. Ann Surg Oncol, 2015, 22 (Suppl 3): 848-854.

1. Zhang H, Wang J, Wang W, et al. A meta-analysis of esophagec-tomy: the comparative study of Ivor-Lewis operation and Sweet operation. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 892-897.
2. 冒志明, 顾晓华, 李昌炎, 等. Ivor-Lewis经胸颈部机械吻合术治疗中段食管癌的前瞻性研究.中华消化外科杂志, 2013, 12(10): 754-758.
3. Lin J, Kang M, Lin J, et al. Short-term efficacy comparison between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 888-891.
4. Uzzaman MM, Daniel RJ, Mhandu PC, et al. A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy. Ann Thorac Surg, 2014, 97(1): 365-372.
5. Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis, 2014, 6(3): 271-284.
6. 郭予雄, 何少茹, 钟敏泉, 等.小儿先天性心脏病术后乳糜胸的诊断和治疗.中国胸心血管外科临床杂志, 2015, 22(8): 734-738.
7. Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
8. Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesopha-gogastric anastomosis: single-centre analysis of 415 oesophagec-tomies. Eur J Cardiothorac Surg, 2016, 49(6): 1650-1659.
9. 孙振宇, 顾敏威, 赵永, 等.食管贲门癌术后胸内吻合口狭窄的临床分析.南京医科大学学报(自然科学版), 2010, 30(8): 1211-1213.
10. De Giacomo T, Francioni F, Venuta F, et al. Complete mechanical cervical anastomosis using a narrow gastric tube after esophagec-tomy for cancer. Eur J Cardiothorac Surg, 2004, 26(5): 881-884.
11. Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psycho-metric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
12. 杨国明, 王会志, 董驹, 等.贲门癌、食管癌切除术后食管-胃肌瓣胃腔内瓣膜式吻合术的测压观察.河北医科大学学报, 2011, 32(6): 699-700.
13. 王文凭, 陈龙奇.食管癌外科治疗的现状与展望.中国胸心血管外科临床杂志, 2011, 18(1): 58-65.
14. Li B, Xiang J, Zhang Y, et al. Factors affecting hospital mortality in patients with esophagogastric anastomotic leak: a retrospective study. World J Surg, 2016, 40(5): 1152-1157.
15. 段红兵, 李敏杰, 康健乐.管状胃成形对预防食管癌切除术后胃食管反流的作用.中国胸心血管外科临床杂志, 2010, 17(5): 417-419.
16. 臧其威, 郑中锋, 陈伟.食管胃高位胸顶吻合加纵膈胸膜减张覆盖在食管癌手术中的应用.齐齐哈尔医学院学报, 2010, 31(5): 708-709.
17. Asteriou C, Barbetakis N, Lalountas M, et al. Modified pleural tenting for prevention of anastomotic leak after ivor lewis esopha-gogastrectomy. Ann Surg Oncol, 2011, 18(13): 3737-3742.
18. 姜志良, 杨继武, 王林, 等.经食管床吻合术后对残余食管的压力测定和酸碱度分析.中华胃肠外科杂志, 2008, 11(1): 32-35.
19. 赵雍凡, 王资斌, 伍伫, 等.不同平面胃食管吻合术后食管腔内24小时pH监测.中国胸心血管外科临床杂志, 1998, 5(3): 19-20.
20. Honda M, Wakita T, Onishi Y, et al. development and validation of a disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer. Ann Surg Oncol, 2015, 22 (Suppl 3): 848-854.

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Application of Pleural Tenting in Ivor-Lewis Esophagogastrectomy: A Randomized Controlled Trial

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