Different intrathoracic anastomotic strategies for proximal esophageal dilatation in 654 patients with esophageal: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yucheng ¹ , ZHUO Zeguo ^1,2 , ZHONG Xia ¹ , ZHAO Yongsheng ¹ ,  LIN Yidan ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, 310030, P. R. China;

Corresponding author：

LIN Yidan, Email: linyidan.academy@foxmail.com

Keywords：

Esophageal cancer; anastomotic leakage; esophageal diameter; risk assessment; anastomosis methods

DOI：

10.7507/1007-4848.202303035

Video：

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Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.

Citation： WANG Yucheng, ZHUO Zeguo, ZHONG Xia, ZHAO Yongsheng, LIN Yidan. Different intrathoracic anastomotic strategies for proximal esophageal dilatation in 654 patients with esophageal: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 710-717. doi: 10.7507/1007-4848.202303035 Copy

1.	Hagi T, Makino T, Yamasaki M, et al. Dysphagia score as a predictor of adverse events due to triplet chemotherapy and oncological outcomes in 434 consecutive patients with esophageal cancer. Ann Surg Oncol, 2019, 26(13): 4754-4764.
2.	Modi RM, Mikhail S, Ciombor K, et al. Outcomes of nutritional interventions to treat dysphagia in esophageal cancer: A population-based study. Dis Esophagus, 2017, 30(11): 1-8.
3.	Zhuo ZG, Li G, Deng HY, et al. Preoperative dilated esophagus is associated with a high risk of intrathoracic anastomotic leakage for patients with esophageal cancer. J Thorac Dis, 2020, 12(5): 2325-2332.
4.	Tang Z, Cai H, Cui Y. Influence of early postoperative feeding in gastrointestinal anastomotic fistula formation and healing time in rabbits. Biomed Res Int, 2018, 2018: 8258096.
5.	Hong JH, Kim DH, Rhyu IJ, et al. A simple morphometric analysis method for dermal microstructure using color thresholding and moments. Skin Res Technol, 2020, 26(1): 132-136.
6.	Shu J, Dolman G E, Duan J, et al. Statistical colour models: An automated digital image analysis method for quantification of histological biomarkers. Biomed Eng Online, 2016, 15: 46.
7.	Muller J M, Erasmi H, Stelzner M, et al. Surgical therapy of oesophageal carcinoma. Br J Surg, 1990, 77(8): 845-857.
8.	Bardini R, Bonavina L, Asolati M, et al. Single-layered cervical esophageal anastomoses: A prospective study of two suturing techniques. Ann Thorac Surg, 1994, 58(4): 1087-1090.
9.	Akiyama Y, Iwaya T, Endo F, et al. Stability of cervical esophagogastrostomy via hand-sewn anastomosis after esophagectomy for esophageal cancer. Dis Esophagus, 2017, 30(5): 1-7.
10.	Plat VD, Stam WT, Schoonmade LJ, et al. Implementation of robot-assisted Ivor Lewis procedure: Robotic hand-sewn, linear or circular technique? Am J Surg, 2020, 220(1): 62-68.
11.	Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4): 583-588.
12.	Takeuchi H, Oyama T, Saikawa Y, et al. Novel thoracoscopic intrathoracic esophagogastric anastomosis technique for patients with esophageal cancer. J Laparoendosc Adv Surg Tech A, 2012, 22(1): 88-92.
13.	Ikeda T, Kumashiro R, Taketani K, et al. Endoscopic evaluation of clinical colorectal anastomotic leakage. J Surg Res, 2015, 193(1): 126-134.
14.	Son GM, Kwon MS, Ahn HM, et al. Compression injury of the circular stapler for gastrointestinal end-to-end anastomosis: preliminary in-vitro study. Ann Surg Treat Res, 2020, 99(2): 72-81.
15.	Xia F, Mao J, Ding J, et al. Observation of normal appearance and wall thickness of esophagus on CT images. Eur J Radiol, 2009, 72(3): 406-411.
16.	Marini T, Desai A, Kaproth-Joslin K, et al. Imaging of the oesophagus: Beyond cancer. Insights Imaging, 2017, 8(3): 365-376.
17.	Trombetta-eSilva J, Rosset EA, Hepfer RG, et al. Decreased mechanical strength and collagen content in sparc-null periodontal ligament is reversed by inhibition of transglutaminase activity. J Bone Miner Res, 2015, 30(10): 1914-1924.
18.	Prawira AY, Hosaka YZ, Novelina S, et al. Morphological evaluation of polysaccharide content and collagen composition during cutaneous wound healing in the Sunda porcupine (Hystrix javanica). J Vet Med Sci, 2020, 82(5): 506-515.
19.	Avila RM, Rodriguez BL, Sanchez ML. Collagen: A review on its sources and potential cosmetic applications. J Cosmet Dermatol, 2018, 17(1): 20-26.

1. Hagi T, Makino T, Yamasaki M, et al. Dysphagia score as a predictor of adverse events due to triplet chemotherapy and oncological outcomes in 434 consecutive patients with esophageal cancer. Ann Surg Oncol, 2019, 26(13): 4754-4764.
2. Modi RM, Mikhail S, Ciombor K, et al. Outcomes of nutritional interventions to treat dysphagia in esophageal cancer: A population-based study. Dis Esophagus, 2017, 30(11): 1-8.
3. Zhuo ZG, Li G, Deng HY, et al. Preoperative dilated esophagus is associated with a high risk of intrathoracic anastomotic leakage for patients with esophageal cancer. J Thorac Dis, 2020, 12(5): 2325-2332.
4. Tang Z, Cai H, Cui Y. Influence of early postoperative feeding in gastrointestinal anastomotic fistula formation and healing time in rabbits. Biomed Res Int, 2018, 2018: 8258096.
5. Hong JH, Kim DH, Rhyu IJ, et al. A simple morphometric analysis method for dermal microstructure using color thresholding and moments. Skin Res Technol, 2020, 26(1): 132-136.
6. Shu J, Dolman G E, Duan J, et al. Statistical colour models: An automated digital image analysis method for quantification of histological biomarkers. Biomed Eng Online, 2016, 15: 46.
7. Muller J M, Erasmi H, Stelzner M, et al. Surgical therapy of oesophageal carcinoma. Br J Surg, 1990, 77(8): 845-857.
8. Bardini R, Bonavina L, Asolati M, et al. Single-layered cervical esophageal anastomoses: A prospective study of two suturing techniques. Ann Thorac Surg, 1994, 58(4): 1087-1090.
9. Akiyama Y, Iwaya T, Endo F, et al. Stability of cervical esophagogastrostomy via hand-sewn anastomosis after esophagectomy for esophageal cancer. Dis Esophagus, 2017, 30(5): 1-7.
10. Plat VD, Stam WT, Schoonmade LJ, et al. Implementation of robot-assisted Ivor Lewis procedure: Robotic hand-sewn, linear or circular technique? Am J Surg, 2020, 220(1): 62-68.
11. Zhu ZJ, Zhao YF, Chen LQ, et al. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg, 2008, 32(4): 583-588.
12. Takeuchi H, Oyama T, Saikawa Y, et al. Novel thoracoscopic intrathoracic esophagogastric anastomosis technique for patients with esophageal cancer. J Laparoendosc Adv Surg Tech A, 2012, 22(1): 88-92.
13. Ikeda T, Kumashiro R, Taketani K, et al. Endoscopic evaluation of clinical colorectal anastomotic leakage. J Surg Res, 2015, 193(1): 126-134.
14. Son GM, Kwon MS, Ahn HM, et al. Compression injury of the circular stapler for gastrointestinal end-to-end anastomosis: preliminary in-vitro study. Ann Surg Treat Res, 2020, 99(2): 72-81.
15. Xia F, Mao J, Ding J, et al. Observation of normal appearance and wall thickness of esophagus on CT images. Eur J Radiol, 2009, 72(3): 406-411.
16. Marini T, Desai A, Kaproth-Joslin K, et al. Imaging of the oesophagus: Beyond cancer. Insights Imaging, 2017, 8(3): 365-376.
17. Trombetta-eSilva J, Rosset EA, Hepfer RG, et al. Decreased mechanical strength and collagen content in sparc-null periodontal ligament is reversed by inhibition of transglutaminase activity. J Bone Miner Res, 2015, 30(10): 1914-1924.
18. Prawira AY, Hosaka YZ, Novelina S, et al. Morphological evaluation of polysaccharide content and collagen composition during cutaneous wound healing in the Sunda porcupine (Hystrix javanica). J Vet Med Sci, 2020, 82(5): 506-515.
19. Avila RM, Rodriguez BL, Sanchez ML. Collagen: A review on its sources and potential cosmetic applications. J Cosmet Dermatol, 2018, 17(1): 20-26.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Different intrathoracic anastomotic strategies for proximal esophageal dilatation in 654 patients with esophageal: A retrospective cohort study

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