The relations between cervical esophageal pressure difference with the formation of cervical anastomotic leakage_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Han ¹ , ZHANG Yaochao ¹ ,  LIU Lijun ^1,2 , SONG Yongbin ²

1. Graduate School of Hebei Medical University, Shijiazhuang, 050001, P.R.China;
2. Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, 050051, P.R.China;

Corresponding author：

LIU Lijun, Email: hbghxiongwaike@126.com

Keywords：

Esophageal cancer; anastomotic leakage; pressure difference

DOI：

10.7507/1007-4848.201610053

Video：

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Objective To confirm the difference between internal and external pressure of cervical esophageal and to discuss the relations between cervical esophageal pressure difference with the formation of cervical anastomotic leakage. Methods In the present study, 12 New Zealand white rabbits were used. We applied a pressure transducer to describe the variation of pressure of intrathoracic, thoracic esophagus, cervical esophagus and upper esophageal sphincter during resting and cough. Pressure value was recorded and read through MD3000 system. And the difference between each point was analyzed. Results The pressures resulting from the cough induced were significantly higher in intrathoracic than in thoracical esophagous (10.2±0.6 cm H₂O vs. 36.7±1.0 cm H₂O), exhibited significantly higher in upper esophageal sphincter and thoracic esophagous than in cervical esophageal (7.5±0.2 cm H₂O vs. 12.0±0.4 cm H₂O, vs. 10.2±0.6 cm H₂O). Conclusion Cervical anastomotic leaks are affected by many factors.And the most notabe one is the constant pressure from inside-out around cervical anastomotic.

Citation： ZHANG Han, ZHANG Yaochao, LIU Lijun, SONG Yongbin. The relations between cervical esophageal pressure difference with the formation of cervical anastomotic leakage. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(8): 630-634. doi: 10.7507/1007-4848.201610053 Copy

1.	Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut, 2005, 54(4): 449-454.
2.	Palombini BC, Villanova CAC, Araujo E, et al. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest, 1999, 116(2): 279-284.
3.	Yapici O, Basoglu T, Canbaz F, et al. The role of coughing as a gastroesophageal-reflux provoking maneuver: the scintigraphical evaluation. Nucl Med Commun, 2009, 30(6): 440-444.
4.	Smith J, Woodcock A, Houghton L. New developments in reflux-associated cough. Lung, 2010, 188(1): 81-86.
5.	Kollarik M, Brozmanova M. Cough and gastroesophageal reflux: insights from animal models. Pulm Pharmacol Ther, 2009, 22(2): 130-134.
6.	Smith JA, Decalmer S, Kelsall A, et al. Acoustic cough—reflux associations in chronic cough: potential triggers and mechanisms. Gastroenterology, 2010, 139(3): 754-762.
7.	Ing AJ, Ngu MC, Breslin AB. Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. Am J Respir Crit Care Med, 1994, 149(1): 160-167.
8.	Amaris M, Dua KS, Naini SR, et al. Characterization of the upper esophageal sphincter response during cough. Chest, 2012, 142(5): 1229-1236.
9.	徐淑云, 主编. 药理实验方法学. 第 1 版. 北京:人民卫生出版社, 1982. 913-922.
10.	Eberl T, Jagoditsch M, Klingler A, et al. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg, 2008, 196(4): 592-598.
11.	Tsujimoto H, Ono S, Takahata R, et al. Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy. Surg Today, 2012, 42(2): 141-146.
12.	Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg, 2003, 238(6): 803-814.
13.	Biere S, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg, 2011, 28(1): 29-35.
14.	Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg, 1995, 169(6): 634-640.
15.	方文涛, 陈文虎, 范利民, 等. 食管癌切除术后不同重建途径吻合口瘘的原因及预防. 中华胃肠外科杂志, 2005, 8(3): 217-219.
16.	Stephens FO, Hunt TK. Effect of changes in inspired oxygen and carbon dioxide tensions on wound tensile strength: an experimental study. Ann Surg, 1971, 173(4): 515.
17.	LaVan FB, Hunt TK. Oxygen and wound healing. Clin Plast Surg, 1990, 17(3): 463-472.
18.	Nieponice A, Gilbert TW, Badylak SF. Reinforcement of esophageal anastomoses with an extracellular matrix scaffold in a canine model. Ann Thorac Surg, 2006, 82(6): 2050-2058.
19.	Schilling MK, Redaelli C, Maurer C, et al. Gastric microcirculatory changes during gastric tube formation: assessment with laser Doppler flowmetry. J Surg Res, 1996, 62(1): 125-129.
20.	Ikeda Y, Niimi M, Kan S, et al. Clinical significance of tissue blood flow during esophagectomy by laser Doppler flowmetry. J Thorac Cardiovasc Surg, 2001, 122(6): 1101-1106.
21.	Fietkau R, Lewitzki V, Kuhnt T, et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: Results of a randomized, controlled, multicenter trial. Cancer, 2013, 119(18): 3343-3353.
22.	Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq Gastroenterol, 2012, 49(3): 227-231.

1. Sifrim D, Dupont L, Blondeau K, et al. Weakly acidic reflux in patients with chronic unexplained cough during 24 hour pressure, pH, and impedance monitoring. Gut, 2005, 54(4): 449-454.
2. Palombini BC, Villanova CAC, Araujo E, et al. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest, 1999, 116(2): 279-284.
3. Yapici O, Basoglu T, Canbaz F, et al. The role of coughing as a gastroesophageal-reflux provoking maneuver: the scintigraphical evaluation. Nucl Med Commun, 2009, 30(6): 440-444.
4. Smith J, Woodcock A, Houghton L. New developments in reflux-associated cough. Lung, 2010, 188(1): 81-86.
5. Kollarik M, Brozmanova M. Cough and gastroesophageal reflux: insights from animal models. Pulm Pharmacol Ther, 2009, 22(2): 130-134.
6. Smith JA, Decalmer S, Kelsall A, et al. Acoustic cough—reflux associations in chronic cough: potential triggers and mechanisms. Gastroenterology, 2010, 139(3): 754-762.
7. Ing AJ, Ngu MC, Breslin AB. Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. Am J Respir Crit Care Med, 1994, 149(1): 160-167.
8. Amaris M, Dua KS, Naini SR, et al. Characterization of the upper esophageal sphincter response during cough. Chest, 2012, 142(5): 1229-1236.
9. 徐淑云, 主编. 药理实验方法学. 第 1 版. 北京:人民卫生出版社, 1982. 913-922.
10. Eberl T, Jagoditsch M, Klingler A, et al. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg, 2008, 196(4): 592-598.
11. Tsujimoto H, Ono S, Takahata R, et al. Systemic inflammatory response syndrome as a predictor of anastomotic leakage after esophagectomy. Surg Today, 2012, 42(2): 141-146.
12. Walther B, Johansson J, Johnsson F, et al. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg, 2003, 238(6): 803-814.
13. Biere S, Maas KW, Cuesta MA, et al. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg, 2011, 28(1): 29-35.
14. Urschel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg, 1995, 169(6): 634-640.
15. 方文涛, 陈文虎, 范利民, 等. 食管癌切除术后不同重建途径吻合口瘘的原因及预防. 中华胃肠外科杂志, 2005, 8(3): 217-219.
16. Stephens FO, Hunt TK. Effect of changes in inspired oxygen and carbon dioxide tensions on wound tensile strength: an experimental study. Ann Surg, 1971, 173(4): 515.
17. LaVan FB, Hunt TK. Oxygen and wound healing. Clin Plast Surg, 1990, 17(3): 463-472.
18. Nieponice A, Gilbert TW, Badylak SF. Reinforcement of esophageal anastomoses with an extracellular matrix scaffold in a canine model. Ann Thorac Surg, 2006, 82(6): 2050-2058.
19. Schilling MK, Redaelli C, Maurer C, et al. Gastric microcirculatory changes during gastric tube formation: assessment with laser Doppler flowmetry. J Surg Res, 1996, 62(1): 125-129.
20. Ikeda Y, Niimi M, Kan S, et al. Clinical significance of tissue blood flow during esophagectomy by laser Doppler flowmetry. J Thorac Cardiovasc Surg, 2001, 122(6): 1101-1106.
21. Fietkau R, Lewitzki V, Kuhnt T, et al. A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: Results of a randomized, controlled, multicenter trial. Cancer, 2013, 119(18): 3343-3353.
22. Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq Gastroenterol, 2012, 49(3): 227-231.

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