van Workum Frans, van der Maas Jolijn, van den Wildenberg Frits J H, Polat Fatih, Kouwenhoven Ewout A, van Det Marc J, Nieuwenhuijzen Grard A P, Luyer Misha D, Rosman Camiel
Department of Surgery, Radboudumc, Nijmegen, the Netherlands.
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
Ann Thorac Surg. 2017 Jan;103(1):267-273. doi: 10.1016/j.athoracsur.2016.07.010. Epub 2016 Sep 24.
Both cervical esophagogastric anastomosis (CEA) and intrathoracic esophagogastric anastomosis (IEA) are used to restore gastrointestinal integrity following minimally invasive esophagectomy (MIE). No prospective randomized data on functional outcome, postoperative morbidity, and mortality between these techniques are currently available.
A comparison was conducted including all consecutive patients with esophageal carcinoma of the distal esophagus or gastroesophageal junction undergoing MIE with CEA or MIE with IEA from October 2009 to July 2014 in 3 high-volume esophageal cancer centers. Functional outcome, postoperative morbidity, and mortality were analyzed.
MIE with CEA was performed in 146 patients and MIE with IEA in 210 patients. The incidence of recurrent laryngeal nerve palsy was 14.4% after CEA and 0% after IEA (p < 0.001). Dysphagia, dumping, and regurgitation were reported less frequently after IEA compared with CEA (p < 0.05). Dilatation of benign strictures occurred in 43.8% after CEA and this was 6.2% after IEA (p < 0.001). If a benign stricture was identified, it was dilated a median of 4 times in the CEA group and only once in the IEA group (p < 0.001). Anastomotic leakage for which reoperation was required occurred in 8.2% after CEA and in 11.4% after IEA (not significant). Median ICU stay, hospital stay, in-hospital mortality, 30-day mortality, and 90-day mortality were similar between the groups (not significant).
MIE with IEA was associated with better functional results than MIE with CEA with less dysphagia, less benign anastomotic strictures requiring fewer dilatations, and a lower incidence of recurrent laryngeal nerve palsy. Other postoperative morbidity and mortality did not differ between the groups.
颈段食管胃吻合术（CEA）和胸段食管胃吻合术（IEA）均用于微创食管切除术后（MIE）恢复胃肠道的完整性。目前尚无关于这两种技术在功能结局、术后发病率和死亡率方面的前瞻性随机数据。
对2009年10月至2014年7月期间在3家高容量食管癌中心接受CEA的MIE或IEA的MIE治疗的所有连续性远端食管癌或胃食管交界部癌患者进行比较。分析功能结局、术后发病率和死亡率。
146例患者接受了CEA的MIE，210例患者接受了IEA的MIE。CEA术后喉返神经麻痹的发生率为14.4%，IEA术后为0%（p<0.001）。与CEA相比，IEA术后吞咽困难、倾倒综合征和反流的报告频率较低（p<0.05）。CEA术后良性狭窄扩张发生率为43.8%，IEA术后为6.2%（p<0.001）。如果发现良性狭窄，CEA组中位扩张4次，IEA组仅1次（p<0.001）。CEA术后需要再次手术的吻合口漏发生率为8.2%，IEA术后为11.4%（无统计学意义）。两组间ICU住院时间中位数、住院时间、住院死亡率、30天死亡率和90天死亡率相似（无统计学意义）。
与CEA的MIE相比，IEA的MIE功能结果更好，吞咽困难更少，需要扩张的良性吻合口狭窄更少，喉返神经麻痹发生率更低。两组间其他术后发病率和死亡率无差异。
