Sillah K, Griffiths E A, Pritchard S A, Swindell R, West C M, Page R, Welch I M
Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2009 Apr;91(3):195-200. doi: 10.1308/003588409X359268. Epub 2009 Feb 13.
Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed.
The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out.
Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013).
In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.
已发表的结直肠癌手术数据表明，前切除术之后对吻合口圈进行分析并无作用。上消化道吻合口圈的常规组织学分析的实用性尚不清楚。我们的研究评估了吻合口圈受癌累及对临床实践的影响。还分析了与吻合口圈受累及相关的因素以及对患者生存的影响。
回顾性分析了1994年至2006年期间在两个专科中心接受了可能治愈性食管癌胃切除术并采用吻合器吻合的462例患者的临床病理细节。进行了单因素、多因素和生存分析。
约5%的吻合口圈（462例中的22例）在组织学上受癌累及。近端切缘的显微镜下累及、局部淋巴结转移以及主要切除标本内的淋巴管浸润与吻合口圈受累及独立相关（所有P<0.05）。然而，这三个因素综合起来未能预测吻合口圈受累及情况。吻合口圈受累及是总生存的独立不良预后因素（P = 0.0013）。
与结直肠癌手术的结果相反，食管癌胃切除术后吻合口圈受癌累及似乎具有有用的预后信息。对上消化道吻合口圈进行常规组织学分析是合理的。吻合口圈受累及可能会在未来加强辅助治疗的指征。
