Chasseray V M, Kiroff G K, Buard J L, Launois B
School of Medicine, University of Rennes, France.
Surg Gynecol Obstet. 1989 Jul;169(1):55-62.
A prospective trial was conducted to compare intrathoracic and cervical anastomoses after esophagectomy for squamous cell carcinoma of the middle or lower one-third of the esophagus. One hundred and twenty-three patients were randomized to have either a cervical or thoracic anastomosis. Thirty-one patients were subsequently excluded either because esophagectomy was performed without thoracotomy or the tumor was unresectable or because the randomization protocol was not complied with. Transfusion requirements and operating time were similar for the 49 patients having esophagectomy by way of the laparotomy and right thoracotomy (TA) and the 43 patients who underwent laparotomy, right thoracotomy and cervicotomy (CA). Forty-three per cent of the CA and 49 per cent of the TA patients had involved lymph nodes. An esophagectomy incorporating a cervical anastomosis resulted in a significantly greater margin of macroscopically normal esophagus above the tumor (median of 4.0 versus 1.5 centimeters for TA). A leak was significantly more frequent after cervical anastomosis (26 per cent) than thoracic (4 per cent) (p less than 0.002). Respiratory complications were more frequent with a thoracic anastomosis, but this was not statistically significant. Thirty day mortality rates were similar for the two groups: 14.3 per cent, TA, and 9.3 per cent, CA (p = N.S.). Postoperative strictures occurred in 14 per cent of TA and 23 per cent of CA patients and were most common after an anastomotic leak. The survival patterns of the two groups were similar. The median survival time for CA patients was 23 months and for TA, 20 months. Excluding hospital mortality, 47 per cent of patients were alive at two years and 30 per cent at 40 months. Survival was related to extent of disease. The greater length of tumor-free esophagus removed with a cervical anastomosis did not result in an improved long term survival period, but was associated with a significantly higher incidence of anastomotic fistula.
开展了一项前瞻性试验，以比较食管中下段鳞状细胞癌行食管切除术后胸内吻合与颈部吻合的效果。123例患者被随机分为颈部吻合组或胸内吻合组。随后，31例患者被排除，原因包括未开胸进行食管切除术、肿瘤无法切除或未遵循随机分组方案。通过剖腹术和右胸切开术（TA）进行食管切除术的49例患者与接受剖腹术、右胸切开术和颈部切开术（CA）的43例患者的输血需求和手术时间相似。CA组43%的患者和TA组49%的患者有淋巴结受累。采用颈部吻合的食管切除术在肿瘤上方切得的肉眼可见正常食管边缘明显更宽（TA组为1.5厘米，CA组中位数为4.0厘米）。颈部吻合术后吻合口漏的发生率（26%）显著高于胸内吻合（4%）（p<0.002）。胸内吻合术后呼吸并发症更常见，但无统计学意义。两组的30天死亡率相似：TA组为14.3%，CA组为9.3%（p=无统计学差异）。TA组14%的患者和CA组23%的患者术后出现狭窄，吻合口漏后最为常见。两组的生存模式相似。CA组患者的中位生存时间为23个月，TA组为20个月。排除医院死亡率后，47%的患者在两年时存活，30%在40个月时存活。生存与疾病范围相关。颈部吻合切除的无肿瘤食管长度更长，但并未带来更长的长期生存期，反而吻合口瘘的发生率显著更高。
