Objective To compare short-term quality of life and postoperative complications in esophageal squamous cell carcinoma patients with different routes reconstruction after McKeown esophagectomy. Methods The clinical data of 144 patients with esophageal squamous cell carcinoma who received McKeown esophagectomy in Shanghai Chest Hospital from January 2016 to October 2016 were retrospectively reviewed. Among them 93 patients accepted retrosternal approach (a RR group, 71 males and 22 females at an average age of 63.5±7.7 years) and 51 patients accepted posterior mediastinal approach (a PR group, 39 males and 12 females at an average age of 62.3±8.0 years). Short-term surgical outcomes were compared and a Quality of Life Questionnaire of Patients Underwent Esophagectomy 1.0 was performed at postoperative 1st and 3rd month. Results There was no difference in two groups in sex, age, Body Mass Index (BMI), and location and clinical stage of tumors (P>0.05). The neoadjuvant therapy was more performed in the RR group (16.1%vs. 5.9%, P=0.075). There were more robot-assisted esophagecctomy operations performed in the PR group (52.9% vs. 45.2%, P=0.020). No significant difference was noted in operation duration, intraoperative blood loss or length of ICU stay between the RR and PR groups (251.3±59.1 min vs. 253.1±27.7 min, P=0.862; 223.7±75.1 ml vs. 240.0±75.1 ml, P=0.276; 3.7±6.6 d vs. 2.3±2.1 d, P=0.139). The patients in the PR group had more lymph nodes dissected and shorter hospital stay (P<0.001). Rate of R1/2 resection was higher in the RR group (12.9%vs. 5.9%, P=0.187). No surgery-related mortality was observed in both groups. The anastomotic leak and the anastomotic stricture was higher in the RR group than that in the PR group (25.8% vs. 5.9%, P=0.003). No significant difference was found between the two groups in the quality of life at postoperative 1st and 3rd month. However, the quality of life at postoperative 3rd month significantly improved in both groups (P<0.001). Compared with the PR group, the dysphagia was more severe in the RR group at postoperative 1st month (3.3±1.5 vs. 2.6±1.1, P=0.007), while the reflux symptom was lighter at postoperative 3rd month (3.0±1.8 vs. 3.6±1.6, P=0.045). Conclusion The two different routes reconstruction after McKeown esophagectomy are both safe and feasible. The anterior mediastinal approach increases the risk of anastomotic leak, but with low incidence of reflux symptom.
Esophageal cancer is one of the most common malignant tumors in China. The comprehensive treatment of esophageal cancer based on operation is important. In recent ten years, with the development of surgical techniques and medical instruments, tubular stomach has been widely used. Although the advantages of tubular stomach are becoming more and more obvious, there are still many details and problems for the function and application of tubular stomach worthy of further discussion and study. In this paper, the technical progress, advantages, functions and applications of tubular stomach are reviewed and discussed, and the future prospect is predicted.
ObjectiveTo systematically evaluate the efficacy of tubular stomach and whole stomach reconstruction in the treatment of esophageal cancer.MethodsWe searched PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM databases to collect the randomized controlled trial (RCT) studies on the efficacy comparison between tubular stomach and total gastric reconstruction of esophagus in esophagectomy from their date of inception to May 2019. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of Twenty-nine RCTs were included, and 3 012 patients were involved. The results of meta-analysis showed that the postoperative complications such as anastomotic fistula [RR=0.64, 95%CI (0.50, 0.83), P=0.000 6], anastomotic stenosis [RR=0.65, 95%CI (0.50, 0.86), P=0.002], thoracic gastric syndrome [RR=0.19, 95%CI (0.13, 0.27), P<0.001], reflux esophagitis [RR=0.23, 95%CI (0.19, 0.30), P<0.001], gastric emptying disorder [RR=0.39, 95%CI (0.27, 0.57), P<0.001] and pulmonary infection [RR=0.44, 95%CI (0.31, 0.62), P<0.001] were significantly reduced, and the postoperative quality of life score and satisfaction were higher at 6 months and 1 year in the tubular stomach group (P<0.05). In terms of intraoperative blood loss and postoperative hospital stay, they were better in the tubular stomach group than those in the whole stomach group (P<0.05). However, there was no statistically significant difference between the two groups in operation time, postoperative gastrointestinal decompression time, postoperative closed drainage time, postoperative 1-year, 2-year and 3-year survival rate, postoperative quality of life score at 3 weeks and 3 months, and postoperative life satisfaction at 3 weeks.ConclusionThe tubular stomach is more advantageous than the whole stomach in the reconstruction of esophagus after esophagectomy.
ObjectiveTo 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. MethodsThe 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. ResultsA 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. ConclusionCone-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.