Clinical Application of Tubular Stomach in Cervical Esophageal Reconstruction after Esophagectomy for Esophageal Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Chao , SHI Weiping , SHU Yusheng

Department of Thoracic and Cardiovascular Surgery, Affiliated North Jiangsu Hospital of Yangzhou University, Yangzhou 225001 Jiangsu, P. R. China;;
Email：simon1028@sina. com;

Corresponding author：

Keywords：

Esophageal cancer; Tubular stomach; Esophagectomy

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Abstract： Objective To investigate the clinical application of tubular stomach in cervical esophageal reconstruction after esophagectomy for esophageal cancer. Methods A total of 850 patients with esophageal cancer who underwent esophagectomy through cervico-thoraco-abdominal（3-field）approach between January 2007 and January 2009 in North
Jiangsu Hospital were allocated into the tubular stomach group（group A, n=425） and the whole stomach group （group
B, n=425）by operation order. Group A included 287 male and 138 female patients with their average age of 58.2±11.5 years. Among them, 27 patients had upper esophageal cancer, 346 patients had middle esophageal cancer and 52 patients
had lower esophageal cancer. Group B included 298 male and 127 female patients with their average age of 58.5±12.8 years. Among them, 33 patients had upper esophageal cancer, 338 patients had middle esophageal cancer, and 54 patients
had lower esophageal cancer. Operation time, postoperative length of hospital stay and the incidence of anastomotic leakage, anastomotic stricture, intra-thoracic stomach syndrome and reflux esophagitis of the two groups were compared. Results All the patients recovered uneventfully with no in-hospital death. There was no statistical difference in operation time （175.0±12.8 min vs.171.0±10.5 min，t=1.702，P＞ 0.05）and postoperative length of hospital stay （16.0±8.5 d vs.16.3±8.8 d，t=1.773，P＞ 0.05） between the two groups. During follow-up of six months, the rates of anastomotic leakage（χ2=5.550，P＜ 0.05）, intra-thoracic stomach syndrome （χ2=10.500，P＜ 0.05）and reflux esophagitis（χ2=9.150，P＜ 0.05） of group A were significantly lower than those of group B. There was no significant difference in the incidence of anastomotic stricture （χ2=0.120，P＞ 0.05） between the two groups. Conclusion Tubular stomach is better than whole stomach for cervical esophageal reconstruction after esophagectomy for esophageal cancer since it is more physiologically and anatomically complied. It can decrease the incidence of anastomotic leakage, intra-thoracic stomach syndrome, reflux esophagitis and improve the postoperative quality of life.

Citation： SUN Chao,SHI Weiping,SHU Yusheng,et al .. Clinical Application of Tubular Stomach in Cervical Esophageal Reconstruction after Esophagectomy for Esophageal Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 148-150. doi: Copy

1.	Kim HK, Choi YU, Shim JH, et al. Endoscopic evaluation of the quality of the anastomosis after esophagectomy with gastric tube reconstruction. World J Surg, 2008, 32（9）：2010-2014.
2.	Fuyo Y, Yuji A, Shigeo I, et al. Using the supercharge technique to additionally revascularize the gastric tube after a subtotal esophagectomy for esophageal cancer. Am J Surg, 2006, 191（2）：284-287.
3.	车嘉铭, 项捷, 陈凯, 等. 管状胃在食管、贲门癌手术中的临床应用. 中国胸心血管外科临床杂志, 2010, 17（2）：96-98.
4.	Udagawa H, Akiyama H. Surgical treatment of esophageal cancer： Tokyo experience of the three-field technique. Dis Esophagus, 2001, 14（2）：110-114.
5.	胡成广, 廉建红, 任宾, 等. 胸段食管鳞状上皮细胞癌淋巴结三野清扫的临床研究. 肿瘤研究与临床，2009，21（8）：473-475.
6.	张彬, 刘国津, 张哲, 等. 左颈、右胸、上腹三切口治疗胸中上段食管癌手术评价. 中国综合临床, 2007, 23（2）：170-1717.
7.	石维平, 束余声, 史宏灿, 等. 颈、胸、腹“三切口”食管癌根治术1559例. 中国医师杂志, 2009, 11（3）：378-379.
8.	傅俊惠, 黄建豪, 郑海波, 等. 切除胃小弯的管状胃在食管癌切除食管胃重建术中的应用研究. 中国医师杂志, 2007, 9（7）：9442-9445.
9.	李辉, 宋平平, 刘曙光, 等. 全胃小弯切除、管状胃成形在胸段食管癌手术中的应用. 山东医药, 2009, 49（2）：87-88.
10.	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, 2005, 8（3）：217-219.
11.	张灿斌, 李简, 郑建, 等. 胃管成形术在食管重建中的可行性研究. 河南科技大学学报, 2005, 23（3）：175-179.
12.	苏彦和, 黄壮士, 杨鲲鹏, 等. 食管和贲门癌术后吻合口狭窄的预防措施. 中国医师杂志, 2007, 19（1）：95-96.
13.	阴兵林, 匡裕康, 吴九发, 等. 食管癌前壁单层吻合预防食管癌术后吻合口狭窄167例临床分析. 中外医疗, 2008, 27（19）：39.
14.	侯朋远, 吴庆琛. 食管癌切除术后管状胃与全胃代食管的病人生活质量比较. 中华胸心血管外科杂志, 2010, 26（4）：260-261.
15.	Shibuya S, Fukudo S, Shineba R, et al. High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy. World J Surg, 2003, 27（5）：580-583.

1. 　Kim HK, Choi YU, Shim JH, et al. Endoscopic evaluation of the quality of the anastomosis after esophagectomy with gastric tube reconstruction. World J Surg, 2008, 32（9）：2010-2014.
2. 　Fuyo Y, Yuji A, Shigeo I, et al. Using the supercharge technique to additionally revascularize the gastric tube after a subtotal esophagectomy for esophageal cancer. Am J Surg, 2006, 191（2）：284-287.
3. 　车嘉铭, 项捷, 陈凯, 等. 管状胃在食管、贲门癌手术中的临床应用. 中国胸心血管外科临床杂志, 2010, 17（2）：96-98.
4. 　Udagawa H, Akiyama H. Surgical treatment of esophageal cancer： Tokyo experience of the three-field technique. Dis Esophagus, 2001, 14（2）：110-114.
5. 　胡成广, 廉建红, 任宾, 等. 胸段食管鳞状上皮细胞癌淋巴结三野清扫的临床研究. 肿瘤研究与临床，2009，21（8）：473-475.
6. 　张彬, 刘国津, 张哲, 等. 左颈、右胸、上腹三切口治疗胸中上段食管癌手术评价. 中国综合临床, 2007, 23（2）：170-1717.
7. 　石维平, 束余声, 史宏灿, 等. 颈、胸、腹“三切口”食管癌根治术1559例. 中国医师杂志, 2009, 11（3）：378-379.
8. 　傅俊惠, 黄建豪, 郑海波, 等. 切除胃小弯的管状胃在食管癌切除食管胃重建术中的应用研究. 中国医师杂志, 2007, 9（7）：9442-9445.
9. 　李辉, 宋平平, 刘曙光, 等. 全胃小弯切除、管状胃成形在胸段食管癌手术中的应用. 山东医药, 2009, 49（2）：87-88.
10. 　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, 2005, 8（3）：217-219.
11. 　张灿斌, 李简, 郑建, 等. 胃管成形术在食管重建中的可行性研究. 河南科技大学学报, 2005, 23（3）：175-179.
12. 　苏彦和, 黄壮士, 杨鲲鹏, 等. 食管和贲门癌术后吻合口狭窄的预防措施. 中国医师杂志, 2007, 19（1）：95-96.
13. 　阴兵林, 匡裕康, 吴九发, 等. 食管癌前壁单层吻合预防食管癌术后吻合口狭窄167例临床分析. 中外医疗, 2008, 27（19）：39.
14. 　侯朋远, 吴庆琛. 食管癌切除术后管状胃与全胃代食管的病人生活质量比较. 中华胸心血管外科杂志, 2010, 26（4）：260-261.
15. 　Shibuya S, Fukudo S, Shineba R, et al. High incidence of reflux esophagitis observed by routine endoscopic examination after gastric pull-up esophagectomy. World J Surg, 2003, 27（5）：580-583.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Application of Tubular Stomach in Cervical Esophageal Reconstruction after Esophagectomy for Esophageal Cancer

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