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.
Objective To investigate the effect on motility function of remnant esophagus and intrathoracic stomach after esophagectomy for esophageal and cardiac carcinoma. Methods Thirty nine patients with esophageal and cardiac carcinoma were divided into two groups according to surgical procedure. Group of anastomosis above aortic arch （n = 21）： esophagogastrostomy was performed above the aortic arch in patients with esophageal carcinoma of the middle third; group of anastomosis below aortic arch（n= 18）： esophagogastrostomy was performed below the aortic arch in patients with esophageal carcinoma of the low third and cardiac carcinoma. Six health volunteers without gastroesophageal reflux were recruited as control group. Esophageal manometry and upper alimentary tract roentgenography were performed in all patients. Results There was a high pressure zone at the anastomotic orifice in parts of patients of both anastomosis groups. The resting pressure of remnant esophagus was higher than that in control group （P〈0. 05）, and similar to the resting pressure of intrathoracic stomach （P〉0. 05）. There was no significant difference in resting pressure of remnant esophagus and intrathoracic stomach between two anastomosis groups （P〉0.05）. The amplitude and number of primary peristalsis in remnant esophagus of group of anastomosis above aortic arch were significantly reduced in comparison with control group. The number of primary peristalsis in remnant esophagus of group of anastomosis above aortic arch was significantly lower than that of group of anastomosis below aortic arch （P〈0. 05）. The motility in the body of intrathoracic stomach was not observed. Weak motor activity of the gastric antrum was observed with upper alimentary tract roentgenography after surgery and evidently recovered 1 year after surgery. Conclusions The resting pressure of remnant esophagus and intrathoracic stomach is not influenced by the site of anastomosis. Esophagogastric anastomosis at the upper thorax is likely to result in poor motility of remnant esophagus. The motor activity of intrathoracic stomach becomes weak after esophagectomy and then recovers gradually over time, hut still fail to return to normal level.
Objective To explore the comprehensive treatment of synchronous double cancers of the esophagus and stomach. Methods The treatment procedures of 8 patients with synchronous double cancers of the esophagus andstomach admitted in the Department of Digestive Tumor Surgery of The Hospital of Traditional Chinese Medicine of Jiangsu Province between Oct. 2006 to Feb. 2013 were analyzed. Some experience of comprehensive treatment of synch-ronous double cancers of the esophagus and stomach was explored. Results Eight cases of synchronous double cancers of the esophagus and stomach were all diagnosed by endoscopic biopsy. According to the results of CT and endoscopic ultrasonography assessment， lesions which were staged earlier than T1a were cured by endoscopic mucosal resection（6 cases， including 4 cases of esophagus cancer and 2 cases of gastric cancer）， and resection operation （1 cases of esop-hagus cancer）. The lesions staged later than T2 were treated by preoperative neoadjuvant chemoradiation， surgery， and adjuvant chemoradiation after operation （8 cases， including 2 cases of esophagus cancer and 6 cases of gastric cancer）， and simple operation （1 case）. Eight patients had been followed-up for 10-76 months （averaged 41.3 months）. Six patients survived without recurrence and metastasis during the followed-up， 1 patient died in 7 months after operation， and 1 patient relapsed in 20 months after operation. Conclusions Individually designed comprehensive treatment using neo-chemotherapy， intervention chemotherapy， radio-chemotherapy， radical resction surgery， adjuvant chemotherapy， and endoscopic mucosal resection can treat synchronous double cancers of the esophagus and stomach effectively. Impr-actical pursuit for radical surgery will not result in good prognosis
Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer. Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzedretrospectively， and surgical experience was summarized. Results The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection. Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
ObjectiveTo summarize the procedure of transumbilical single incision laparoscopic surgery (SILS) with conventional laparoscopic instruments for different tumor diameter and different site of gastric stromal tumor. MethodThe clinical data, intraoperative procedure, and postoperative recovery of 34 patients with gastric stromal tumor from December 2009 to February 2014 in this hospital were analyzed retrospectively. ResultsThe transumbilical SILS was performed successfully in all the 34 patients.Among these patients, the wedge resection of stomach was perfor-med in 27 patients, distal subtotal gastrectomy was performed in 6 patients, distal subtotal gastrectomy complicated with multivisceral resection was performed in 1 patient.The pathology confirmed that the diameter of tumors was from 0.6 cm to 10.0 cm (average 3.4 cm).The resection margins were tumor free.The risk assessment showed that tumors with extremely low risk were in 9 cases, low risk were in 17 cases, intermediate risk were in 6 cases, high risk were in 2 cases.During surgery, 9 tumors were located on the fundus of stomach, 6 tumors on the gastric greater curvature, 7 tumors on the gastric lesser curvature, 2 tumors on the anterior and posterior wall of the stomach respectively, 3 tumors on the cardia below, 4 tumors on the gastric antrum, tumor invaded the surrounding organs in 1 case.There was no conversion to open or conventional laparoscopic surgery.no intraoperative or postoperative complications were experi-enced in all the patients except one was postoperative intraperitoneal bleeding and one was incision infection.All the patients were followed for an average of 25 months (range 3-49 months), there was no evident recurrence of disease. ConclusionsThe transumbilical SILS for gastric stromal tumor is a feasible and safe technique when performed by an experienced laparoscopic surgeon.The suitable procedure of SILS should be selected for gastric stromal tumor according their different size and location.
ObjectiveTo compare clinical outcomes between triluminal-tube feeding combined with tubular stomach and traditional esophagectomy for the treatment of esophageal carcinoma (EC)in elderly patients. MethodsA total of 196 elderly patients (>60 years)with EC who received esophagectomy in the Department of Cardiothoracic Surgery, Mianyang Central Hospital from January 2007 to January 2013 were enrolled in this study. According to different surgical methods, all the patients were divided into triluminal-tube feeding combined with tubular stomach group (group A)and traditional esophagectomy group (group B). There were 96 patients including 51 males and 45 females in group A with their age of 60-81 (66.21±7.32)years, and 100 patients including 54 males and 46 females in group B with their age of 60-82 (65.43±6.37)years. Clinical indexes were compared between the 2 groups. ResultsRadical esophagectomy was successfully performed for all the patients. There was no statistical difference in operation time, intraoperative blood loss, postoperative incidence of chylothorax, recurrent laryngeal nerve paralysis, anastomotic leakage, anastomotic stricture or mortality between the 2 groups (P > 0.05). Time to first passage of flatus and postoperative length of hospital stay of group A were significantly shorter than those of group B, and the incidences of postoperative arrhythmias, pulmonary complications and thoracic-stomach syndrome of group A were significantly lower than those of group B (P < 0.05). ConclusionTriluminal-tube feeding combined with tubular stomach can significantly reduce postoperative morbidity, shorten hospital stay and improve quality of life of elderly patients undergoing esophagectomy.
ObjectiveTo systematically review the complications and quality of life (QoL) in patients with esophageal cancer after esophagectomy using gastric tube. MethodsRandomized controlled trials (RCTs) about the postoperative complications and QoL of patients using gastric tube and the whole stomach reconstruction were electronically searched in PubMed, EMbase, The Cochrane Library, Web of Knowledge, CBM, CNKI, VIP and WanFang Data from inception to September 30th, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 085 patients were included. The results of meta-analysis showed that, in terms of postoperative complications, the incidences of reflux esophagitis (OR=0.19, 95%CI 0.12 to 0.32, P < 0.000 01) and intrathoracic stomach syndrome (OR=0.11, 95%CI 0.04 to 0.32, P < 0.000 1) with gastric tube were significantly lower than those of the whole stomach; in terms of QoL, the scores of QoL in the 6th month (MD=18.71, 95%CI 7.72 to 29.71, P=0.000 9) and in the 12th month (MD=22.95, 95%CI 8.21 to 37.69, P=0.002) with gastric tube were significantly higher than those of the whole stomach. In terms of satisfaction degree of QoL, the satisfaction degree of QoL in the 6th month (OR=1.78, 95%CI 1.10 to 2.88, P=0.02) and the 12th month (OR=2.73, 95%CI 1.67 to 4.47, P < 0.000 1) with gastric tube were both significantly higher than those of the whole stomach. ConclusionCompared with the whole stomach reconstruction, the method of gastric tube reconstruction has beneficial effects in reducing the incidences of postoperative complications (such as reflux esophagitis, intrathoracic stomach syndrome) and improves patients' QoL. But there are many uncertain factors about postoperative anastomotic complication and its influence on patients' long-term QoL remains uncertain. Thus, further studies should be conducted.
Objective To compare the outcome of tubular stomach and cervical esophagus laminated anastomosis and mechanical anastomosis. Methods A total of 128 patients with middle and upper esophageal cancer in our hospital from January 2013 to January 2016 were randomly divided into two groups, 64 patients in each group and all patients underwent esophagectomy. In the group A, there were 46 males and 18 females with age of 40–75 years, treated with tubular stomach and cervical esophagus layered anastomosis. There were 51 males and 13 females with age of 43–71 years in the group B receiving mechanical anastomosis. We observed the short-term and long-term efficacy as well as complications. Results In the group A, there was cervical anastomotic fistula in 1 patient, anastomotic stenosis in 2 patients and reflux esophagitis in 12 patients. In the group B, 1 patient suffered chylothorax, 8 patients cervical anastomotic fistula, 4 patients anastomotic stenosis and 14 patients reflux esophagitis. Conclusion Layered anastomosis can effectively reduce the incidence of anastomotic fistula and stenosis. Tubular stomach can effectively prevent and reduce the reflux esophagitis, and the high long-term quality of life will be achieved after the operation.
Objective This study was conducted to evaluate and analyze the clinical effect between subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD), especially compare the incidences of delayed gastric emptying (DGE) between them. Methods The documents about SSPPD and PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and WanFang database. The quality of included studies was assessed according to the Cochrane systematic review methods, and statistical analysis of data was performed by using RevMan 5.3 software. Firstly, comparison of incidence of DGE and other effective indexes between SSPPD group and PPPD group was performed by enrolling all included studies, whether met the DGE standards of International Study Group of Pancreatic Surgery (ISGPS) or not, and then comparison of incidence of DGE and clinical DGE was performed by enrolling included studies that met the DGE standards of ISGPS. Results Ten studies were included, with a total of 804 patients, in which, 433 cases underwent SSPPD and 371 cases underwent PPPD. The results of meta-analysis indicated that, in all the included studies, the total incidence of DGE〔OR = 0.33, 95%CI is (0.17, 0.63),P = 0.000 9〕, and the time of nasogastric tube〔MD = –2.65，95%CI is (–4.49, –0.80),P = 0.005〕, and time of stared liquid diet〔MD = –4.13, 95%CI is (–7.35, –0.91),P = 0.01〕 showed significant differences. The total incidence of DGE, the time of nasogastric tube, and time of stared liquid diet were less in SSPPD group. But there was no significant difference between the SSPPD group and PPPD group in operating time, intraoperative blood loss, time of started solid diet, hospital stay, and incidences of reinsertion of nasogastric tube, pancreatic fistula, intra-abdominal abscess, reoperation, wound infection, postoperative hemorrhage, and mortality (P>0.05). In the 8 studies adopted DGE standard of ISGPS, the total incidence of DGE〔OR = 0.31, 95%CI is (0.15, 0.65)，P = 0.002〕 and incidence of clinical DGE 〔OR = 0.13，95%CI is (0.05, 0.40),P = 0.000 3〕showed significant differences. The total incidence of DGE and incidence of clinical DGE were both lower in SSPPD group. Conclusions Compared with PPPD group, SSPPD group was associated with significantly less incidence of DGE. Meanwhile, the time of the nasogastric tube and started liquid diet are shorter than those of SSPPD. And there is no significant difference in the other aspects.