Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Eur J Cardiothorac Surg. 2012 Aug;42(2):359-63. doi: 10.1093/ejcts/ezs015. Epub 2012 Feb 15.
The retrosternal route has been an alternative for oesophageal reconstruction after oesophagectomy. But the longer route and the higher incidence for cervical anastomotic leakage compared with the posterior mediastinal approach have always hampered its wider use. However, with the recent work reported by Chen and colleagues, the anterior route has been confirmed to provide the shortest physiological distance for oesophageal reconstruction using the stomach. Furthermore, improving the original surgical procedures seemed to improve outcomes. This research aims to evaluate whether modification of the original surgical standard of alimentary tract reconstruction after oesophagectomy can reduce the incidence of anastomotic leakage.
One hundred and two patients were divided into the research group and the control group. Subjects in the research group received the improved three-incision oesophagectomy (right chest/belly/left neck) after which the alimentary tract reconstruction was achieved by using a gastric conduit positioned through the retrosternal route. Patients in the control group received the original surgical procedures. Parameters such as the incidence of anastomotic leakage, pneumonia, length of hospital stay, ICU stay and pathological staging were compared between the two groups.
No significant statistical differences were found in parameters such as age, gender, height, weight, comorbidities, location and length of the tumour and final pathological staging of the patients between the two groups. Similarly, intraoperative and postoperative information such as operating time, hospital stay, pneumonia and volume of blood loss are comparable between the two groups. The incidence of anastomotic leakage was, respectively, 4.84% (3/62) in the research group and 20% (8/40) in the control group. The incidence of anastomotic leakage in the research group was lower than the one in the control group, and the difference was statistically significant (P = 0.037).
Modifications of the original surgical standard including expanding the retrosternal tunnel, widening the gastric tube, resection of the sternothyroid muscle and fixation of the gastric tube, contribute to decreasing the incidence of cervical anastomotic leakage.
胸骨后入路是食管切除术后食管重建的一种替代方法。但与后纵隔入路相比，该入路的路径较长，且颈吻合口漏的发生率较高，这一直阻碍了其更广泛的应用。然而，随着 Chen 等人最近的研究报告，前入路已被证实为使用胃进行食管重建提供最短的生理距离。此外，改进原手术程序似乎可以改善结果。本研究旨在评估改良食管癌术后消化道重建的原手术标准是否能降低吻合口漏的发生率。
102 例患者分为研究组和对照组。研究组接受改良三切口食管癌切除术（右胸/腹部/左颈），然后通过胸骨后途径将胃管定位进行消化道重建。对照组接受原手术治疗。比较两组患者吻合口漏、肺炎、住院时间、ICU 住院时间和病理分期等参数。
两组患者的年龄、性别、身高、体重、合并症、肿瘤部位和长度以及最终病理分期等参数无统计学差异。同样，两组患者的术中及术后资料，如手术时间、住院时间、肺炎和出血量等，均无统计学差异。吻合口漏发生率分别为研究组 4.84%（3/62）和对照组 20%（8/40）。研究组吻合口漏发生率低于对照组，差异有统计学意义（P=0.037）。
包括扩大胸骨后隧道、拓宽胃管、切除胸骨甲状肌和固定胃管在内的原手术标准的修改有助于降低颈吻合口漏的发生率。
