在对食管胃交界部Siewert 2型腺癌进行全胃切除时，经口插入吻合器法食管空肠吻合术与使用圆形吻合器进行体外吻合术的安全性比较。

The safety of esophagojejunostomy via a transorally inserted-anvil method vs extracorporeal anastomosis using a circular stapler during total gastrectomy for Siewert type 2 adenocarcinoma of the esophagogastric junction.

作者信息

Chen Xin-Hua, Hu Yan-Feng, Luo Jun, Chen Yue-Hong, Liu Hao, Lin Tian, Chen Hao, Li Guo-Xin, Yu Jiang

机构信息

Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China.

出版信息

Gastroenterol Rep (Oxf). 2019 Oct 11;8(3):242-251. doi: 10.1093/gastro/goz046. eCollection 2020 Jun.

BACKGROUND

Intracorporeal esophagojejunostomy via a transorally inserted-anvil method during laparoscopic total gastrectomy (LTG) for upper gastric cancer has been demonstrated to be feasible, but the use of this assessment exclusively for Siewert type 2 adenocarcinoma of the esophagogastric junction (AEG) has not been reported.

METHODS

A total of 428 consecutive gastric-cancer patients who underwent LTG in Nanfang Hospital from January 2008 to December 2016 were reviewed. Among these patients, 98 were classified as Siewert type 2 AEG. The patients underwent intracorporeal esophagojejunostomy through either a transorally inserted-anvil method (=27) or extracorporeal anastomosis usinga circular stapler (=71). After generating propensity scores with covariates that were associated with developing anastomotic leakage, 26 patients who underwent esophagojejunostomy via the transorally inserted-anvil method (transoral group) were 1:1 matched with 26 patients who underwent the procedure via extracorporeal anastomosis using a circular stapler (extracorporeal group). The safety after 30 days post-operatively was compared between the two groups.

RESULTS

The transoral group and extracorporeal group were balanced regarding the baseline variables. The operative time, reconstruction duration, number of dissected lymph nodes, length of the proximal resection margins, estimated blood loss, intra-operative complication rate, and post-operative recovery course were not significantly different between the two groups. The mean anvil-insertion completion time (9.7 ± 3.0 vs 13.4 ± 2.0minutes, <0.001) and the median incision length (5.5 vs 7.0cm, <0.001) in the transoral group were shorter than those in the extracorporeal group. The incidence of post-operative complications (26.9% vs 23.1%, =0.749) and the classification of complication severity (=0.939) were similar between the two groups.

CONCLUSIONS

Intracorporeal esophagojejunostomy through a transorally inserted-anvil method may be a potentially safe approach to simplify and optimize the procedure during LTG for Siewert type 2 AEG.

背景

在腹腔镜全胃切除术（LTG）治疗上胃癌时，经口插入吻合器行体内食管空肠吻合术已被证明是可行的，但该评估方法仅用于食管胃交界部（AEG）的Siewert 2型腺癌尚未见报道。

方法

回顾性分析2008年1月至2016年12月在南方医院连续接受LTG的428例胃癌患者。其中，98例被归类为Siewert 2型AEG。患者通过经口插入吻合器法（n = 27）或使用圆形吻合器进行体外吻合（n = 71）行体内食管空肠吻合术。在生成与吻合口漏发生相关的协变量的倾向得分后，将26例行经口插入吻合器法食管空肠吻合术的患者（经口组）与26例行使用圆形吻合器体外吻合术的患者（体外组）进行1:1匹配。比较两组术后30天的安全性。

结果

经口组和体外组在基线变量方面均衡。两组的手术时间、重建时间、清扫淋巴结数目、近端切缘长度、估计失血量、术中并发症发生率和术后恢复过程无显著差异。经口组的平均吻合器插入完成时间（9.7±3.0 vs 13.4±2.0分钟，<0.001）和中位切口长度（5.5 vs 7.0cm，<0.001）均短于体外组。两组术后并发症发生率（26.9% vs 23.1%，P = 0.749）和并发症严重程度分级（P = 0.939）相似。