Comparative analysis of the clinical efficacy of two different methods of digestive tract reconstruction and anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yi , LUO Lei , YANG Yanhui , YAO Yi , ZHENG Delai , LEI Yu , LI Xiaoliang , LI Ji ,  XIE Xiaoyang

Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Neijiang Attached Hospital of Chongqing Medical University, Neijiang, 641000, Sichuan, P. R. China;

Corresponding author：

XIE Xiaoyang, Email: 13990559066@163.com

Keywords：

Thoracoscopic and laparoscopic esophagectomy for esophageal cancer; cone-shaped gastric tube; conventional tubular stomach; stratified manual anastomosis; mechanical side-to-side anastomosis

DOI：

10.7507/1007-4848.202203027

Video：

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Objective To compare the clinical efficacy of cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis and conventional tubular stomach combined with neck end-to-end mechanical side-to-side anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods The clinical data of consecutive patients treated by thoracoscopic and laparoscopic esophagectomy for esophageal cancer in the Department of Cardiothoracic Surgery of the First People's Hospital of Neijiang from January 1, 2018 to March 25, 2021 were analyzed. The patients were divided into a cone-shaped gastric tube manual group (treated with cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis) and a conventional tubular stomach mechanical group (treated with conventional tubular stomach+end-to-end mechanical side-to-side anastomosis). The anastomotic time, intraoperative blood loss, number of lymph node dissection, anastomotic fistula, anastomotic stenosis, anastomotic cost, sternogastric dilatation, gastroesophageal reflux symptoms, and postoperative complications were compared and analyzed between the two groups. Results A total of 161 patients were enrolled, including 112 males and 49 females aged 40-82 years. There were 80 patients in the cone-shaped gastric tube manual group, and 81 patients in the conventional tubular stomach mechanical group. There was no statistical difference in the intraoperative blood loss, number of lymph nodes dissected, hoarseness, pulmonary infection, arrhythmia, respiratory failure or chylothorax between the two groups (P>0.05). The anastomosis time of the cone-shaped gastric tube manual group was longer than that of the conventional tubular stomach mechanical group (28.35±3.20 min vs. 14.30±1.26 min, P<0.001), but the anastomotic cost and incidence of thoracogastric dilatation in the cone-shaped gastric tube manual group were significantly lower than those of the conventional tubular stomach mechanical group [948.48±70.55 yuan vs. 4 978.76±650.29 yuan, P<0.001; 3 (3.8%) vs. 14 (17.3%), P=0.005]. The incidences of anastomotic fistula and anastomotic stenosis in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group, but the differences were not statistically significant (P>0.05). The gastroesophageal reflux scores in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group at 1 month, 3 months, 6 months and 1 year after the operation (P<0.05). Logistic regression analysis showed that digestive tract reconstruction method was the influencing factor for postoperative thoracogastric dilation, which was reduced in the cone-shaped gastric tube manual group. Conclusion Cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis can significantly reduce the incidence of thoracogastric dilatation after thoracoscopic and laparoscopic esophagectomy for esophageal cancer and save hospitalization costs, with mild gastroesophageal reflux symptoms, and it still has certain advantages in reducing postoperative anastomotic fistula and anastomotic stenosis, which is worthy of clinical promotion.

Citation： WANG Yi, LUO Lei, YANG Yanhui, YAO Yi, ZHENG Delai, LEI Yu, LI Xiaoliang, LI Ji, XIE Xiaoyang. Comparative analysis of the clinical efficacy of two different methods of digestive tract reconstruction and anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(12): 1743-1748. doi: 10.7507/1007-4848.202203027 Copy

1.	Liu F, Yang W, Yang W, et al. Minimally invasive or open esophagectomy for treatment of resectable esophageal squamous cell carcinoma? Answer from a real-world multicenter study. Ann Surg, 2021.
2.	Yasuda T, Shiraishi O, Kato H, et al. A comparative study of the lengths of different reconstruction routes used after thoracic esophagectomy. Esophagus, 2021, 18(3): 468-474.
3.	Zhang M, Zhang C, Wu QC. Health-related quality of life and survival among 10-year survivors of esophageal cancer surgery: Gastric tube reconstruction versus whole stomach reconstruction. J Thorac Dis, 2019, 11(8): 3284-3291.
4.	肖鑫, 栾思源, 杨玉赏, 等. 锥形管状胃联合颈部端端分层吻合在胸腹腔镜食管癌切除术中的应用价值. 中华消化外科杂志, 2019, 18(6): 542-548.
5.	Mao CY, Yang YS, Yuan Y, et al. End-to-end versus end-to-side hand-sewn anastomosis for minimally invasive McKeown esophagectomy. Ann Surg Oncol, 2019, 26(12): 4062-4069.
6.	Ben-David K, Tuttle R, Kukar M, et al. Minimally invasive esophagectomy utilizing a stapled side-to-side anastomosis is safe in the Western patient population. Ann Surg Oncol, 2016, 23(9): 3056-3062.
7.	王新, 王铮, 王志宏, 等. 食管癌术后吻合口狭窄的预防. 临床外科杂志, 2021, 29(8): 736-737.
8.	Yadlapati R, Gyawali CP, Pandolfino JE, et al. AGA clinical practice update on the personalized approach to the evaluation and management of GERD: Expert review. Clin Gastroenterol Hepatol, 2022, 20(5): 984-994.
9.	Mederos MA, de Virgilio MJ, Shenoy R, et al. Comparison of clinical outcomes of robot-assisted, video-assisted, and open esophagectomy for esophageal cancer: A systematic review and meta-analysis. JAMA Netw Open, 2021, 4(11): e2129228.
10.	李春震, 王岩, 赵铁军. 食管癌切除后管状胃成型及其改良术式的研究进展. 实用临床医学, 2021, 22(6): 102-106.
11.	Lai Y, Li H, Tian L, et al. Baseball bat-like gastric tube for end-to-side oesophageal-gastric anastomosis decreased risks of anastomotic leakage after oesophagectomy for oesophageal cancer: A retrospective propensity score matched comparative study with 613 patients. Int J Surg, 2022, 98: 106227.
12.	Huang Y, Hu Y, Lin Y, et al. Evaluation of fibrin sealant in prevention of cervical anastomotic leakage after McKeown esophagectomy: A single-center, retrospective study. Ann Surg Oncol, 2021, 28(11): 6390-6397.
13.	Li S, Qiu R, Yuan G, et al. Body composition in relation to postoperative anastomotic leakage and overall survival in patients with esophageal cancer. Nutrition, 2022, 94: 111534.
14.	袁勇, 胡杨, 伍伫, 等. 分层吻合在胸腹腔镜食管癌切除术中的应用. 中华胸心血管外科杂志, 2016, 32(8): 470-473.
15.	Duan X, Bai W, Ma Z, et al. Management and outcomes of anastomotic leakage after McKeown esophagectomy: A retrospective analysis of 749 consecutive patients with esophageal cancer. Surg Oncol, 2020, 34: 304-309.
16.	Mboumi IW, Reddy S, Lidor AO. Complications after esophagectomy. Surg Clin North Am, 2019, 99(3): 501-510.
17.	潘友俊. 食管癌切除管胃食管颈部T形侧侧吻合与圆形端侧吻合的对比分析. 皖南医学院, 2018.
18.	严会志, 张军, 林称意, 等. 食管癌手术中采用左颈部T形全机械侧侧吻合术吻合对相关手术并发症的影响. 临床外科杂志, 2020, 28(4): 338-340.
19.	贾卓奇, 李硕, 王哲, 等. 手工分层吻合法与机械吻合法在胸腹腔镜食管癌切除术胃食管吻合中的应用对比观察. 山东医药, 2021, 61(15): 75-78.
20.	聂洪鑫, 王兵, 杨思豪, 等. 食管癌术后食管胃吻合口瘘危险因素的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2022, 29(2): 166-178.
21.	Hong ZN, Zhang Z, Chen Z, et al. Safety and feasibility of esophagectomy following combined neoadjuvant immunotherapy and chemotherapy for locally advanced esophageal cancer: A propensity score matching. Esophagus, 2022, 19(2): 224-232.
22.	Wang H, Xuan TT, Chen Y, et al. Investigative therapy for advanced esophageal cancer using the option for combined immunotherapy and chemotherapy. Immunotherapy, 2020, 12(10): 697-703.

1. Liu F, Yang W, Yang W, et al. Minimally invasive or open esophagectomy for treatment of resectable esophageal squamous cell carcinoma? Answer from a real-world multicenter study. Ann Surg, 2021.
2. Yasuda T, Shiraishi O, Kato H, et al. A comparative study of the lengths of different reconstruction routes used after thoracic esophagectomy. Esophagus, 2021, 18(3): 468-474.
3. Zhang M, Zhang C, Wu QC. Health-related quality of life and survival among 10-year survivors of esophageal cancer surgery: Gastric tube reconstruction versus whole stomach reconstruction. J Thorac Dis, 2019, 11(8): 3284-3291.
4. 肖鑫, 栾思源, 杨玉赏, 等. 锥形管状胃联合颈部端端分层吻合在胸腹腔镜食管癌切除术中的应用价值. 中华消化外科杂志, 2019, 18(6): 542-548.
5. Mao CY, Yang YS, Yuan Y, et al. End-to-end versus end-to-side hand-sewn anastomosis for minimally invasive McKeown esophagectomy. Ann Surg Oncol, 2019, 26(12): 4062-4069.
6. Ben-David K, Tuttle R, Kukar M, et al. Minimally invasive esophagectomy utilizing a stapled side-to-side anastomosis is safe in the Western patient population. Ann Surg Oncol, 2016, 23(9): 3056-3062.
7. 王新, 王铮, 王志宏, 等. 食管癌术后吻合口狭窄的预防. 临床外科杂志, 2021, 29(8): 736-737.
8. Yadlapati R, Gyawali CP, Pandolfino JE, et al. AGA clinical practice update on the personalized approach to the evaluation and management of GERD: Expert review. Clin Gastroenterol Hepatol, 2022, 20(5): 984-994.
9. Mederos MA, de Virgilio MJ, Shenoy R, et al. Comparison of clinical outcomes of robot-assisted, video-assisted, and open esophagectomy for esophageal cancer: A systematic review and meta-analysis. JAMA Netw Open, 2021, 4(11): e2129228.
10. 李春震, 王岩, 赵铁军. 食管癌切除后管状胃成型及其改良术式的研究进展. 实用临床医学, 2021, 22(6): 102-106.
11. Lai Y, Li H, Tian L, et al. Baseball bat-like gastric tube for end-to-side oesophageal-gastric anastomosis decreased risks of anastomotic leakage after oesophagectomy for oesophageal cancer: A retrospective propensity score matched comparative study with 613 patients. Int J Surg, 2022, 98: 106227.
12. Huang Y, Hu Y, Lin Y, et al. Evaluation of fibrin sealant in prevention of cervical anastomotic leakage after McKeown esophagectomy: A single-center, retrospective study. Ann Surg Oncol, 2021, 28(11): 6390-6397.
13. Li S, Qiu R, Yuan G, et al. Body composition in relation to postoperative anastomotic leakage and overall survival in patients with esophageal cancer. Nutrition, 2022, 94: 111534.
14. 袁勇, 胡杨, 伍伫, 等. 分层吻合在胸腹腔镜食管癌切除术中的应用. 中华胸心血管外科杂志, 2016, 32(8): 470-473.
15. Duan X, Bai W, Ma Z, et al. Management and outcomes of anastomotic leakage after McKeown esophagectomy: A retrospective analysis of 749 consecutive patients with esophageal cancer. Surg Oncol, 2020, 34: 304-309.
16. Mboumi IW, Reddy S, Lidor AO. Complications after esophagectomy. Surg Clin North Am, 2019, 99(3): 501-510.
17. 潘友俊. 食管癌切除管胃食管颈部T形侧侧吻合与圆形端侧吻合的对比分析. 皖南医学院, 2018.
18. 严会志, 张军, 林称意, 等. 食管癌手术中采用左颈部T形全机械侧侧吻合术吻合对相关手术并发症的影响. 临床外科杂志, 2020, 28(4): 338-340.
19. 贾卓奇, 李硕, 王哲, 等. 手工分层吻合法与机械吻合法在胸腹腔镜食管癌切除术胃食管吻合中的应用对比观察. 山东医药, 2021, 61(15): 75-78.
20. 聂洪鑫, 王兵, 杨思豪, 等. 食管癌术后食管胃吻合口瘘危险因素的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2022, 29(2): 166-178.
21. Hong ZN, Zhang Z, Chen Z, et al. Safety and feasibility of esophagectomy following combined neoadjuvant immunotherapy and chemotherapy for locally advanced esophageal cancer: A propensity score matching. Esophagus, 2022, 19(2): 224-232.
22. Wang H, Xuan TT, Chen Y, et al. Investigative therapy for advanced esophageal cancer using the option for combined immunotherapy and chemotherapy. Immunotherapy, 2020, 12(10): 697-703.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparative analysis of the clinical efficacy of two different methods of digestive tract reconstruction and anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer

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