Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical st
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ORIGINAL ARTICLE
Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage Y.-S. Shu • C. Sun • W.-P. Shi • H.-C. Shi S.-C. Lu • K. Wang
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Received: 13 July 2012 / Accepted: 27 January 2013 / Published online: 10 February 2013 Ó Royal Academy of Medicine in Ireland 2013
Abstract Background Esophagectomy through cervico-thoracoabdominal approach is a useful surgical technique in treating patients with esophageal cancer. However, the cervical reconstruction is also known to have a high rate of anastomotic leakage, as well as anastomotic stricture, intrathoracic stomach syndrome, reflux esophagitis and other complications, thereby influencing postoperative recovery and quality of life. Aims The objective of this study was to investigate whether tubular stomach is superior to whole stomach in reducing anastomotic leakage for esophageal reconstruction through the cervico-thoraco-abdominal (3-field) approach. Methods A total of 850 patients undergoing the 3-field esophagectomy were retrospectively included in this study and divided into a tubular stomach reconstruction group (Group A, n = 453) and a whole stomach reconstruction group (Group B, n = 397). All patients underwent
Y.-S. Shu C. Sun (&) W.-P. Shi H.-C. Shi S.-C. Lu K. Wang Department of Cardiothoracic Surgery, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, 98 West Nantong Road, Yangzhou 225001, Jiangsu Province, China e-mail: [email protected] Y.-S. Shu e-mail: [email protected] W.-P. Shi e-mail: [email protected] H.-C. Shi e-mail: [email protected] S.-C. Lu e-mail: [email protected] K. Wang e-mail: [email protected]
esophagectomy through right thorax, left cervical part, abdominal triple incisions and done in esophageal reconstruction by hand-sewn two-layer anastomosis. Results Results revealed that in comparison with whole stomach, esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage (5.5 vs. 9.3 %, P \ 0.05), less manifestation of intrathoracic syndrome (3.3 vs. 9.8 %, P \ 0.001) and less occurence of reflux esophagitis (5.1 vs. 11.1 %, P \ 0.01). However, for the incidence of anastomotic stricture, there was no significant difference between the two groups (9.3 vs. 9.8 %). Conclusions This observation study suggests that for esophageal cancer patients undergoing the 3-field esophagectomy tubular stomach is better than whole stomach for esophageal reconstruction as reflected by a reduced postoperative anastomotic leakage, intrathoracic syndrome and reflux esophagitis. Keywords Tubular stomach 3-field esophagectomy Esophageal cancer Anastomotic leakage Whole stomach Complications
Introduction Esophagectomy through cervico-thoraco-abdominal approach is a useful surgical technique in treating patients with esophageal cancer. This approach facilitates the threefield lymph node dissection, leading to a high feasibility of complete resection of primary tumor and removal of m
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