Takeda Flavio Roberto, Tutihashi Rafael, Tustumi Francisco, Sallum Rubens Antonio Aissar, de Freitas Busnardo Fabio, Ribeiro Ulysses, Cecconello Ivan
Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil.
Department of Plastic Surgery, University of São Paulo Medical School, São Paulo, Brazil.
J Thorac Cardiovasc Surg. 2021 Sep;162(3):688-697.e3. doi: 10.1016/j.jtcvs.2020.06.021. Epub 2020 Jun 26.
Esophagectomy has high rates of morbidity and mortality. Anastomotic leakage is the most frequent complication and is likely caused by diminished anastomotic perfusion. Supercharged microvascular anastomosis has previously been performed in select patients to supplement the blood supply to the graft and anastomosis after esophagectomy. This study aimed to evaluate complications that may arise after performing the supercharged cervical anastomosis for esophagectomy procedure.
This prospective comparative study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were divided into group 1, in which conventional cervical anastomosis was performed, and group 2, in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas in group 2 patients were evaluated using indocyanine and the SPY device (Novadaq Technologies, Inc, Toronto, Ontario, Canada) before and after supercharged cervical anastomosis for esophagectomy. Postesophagectomy complications were also recorded.
The study enrolled 80 patients, which included 62 (77.5%) men, mean age 64.3 years. Groups 1 and 2 comprised 55 patients and 25 patients, respectively. Leakage occurred in 10.5% and 0% of patients in groups 1 and 2, respectively (P = .169), whereas the corresponding anastomotic stricture rates were 14.5% and 4%, respectively (P = .260). Perfusion analyses showed a 26.5% improvement in the anastomotic area after venous anastomosis and a 34.6% improvement after arterial and venous anastomosis.
The supercharged cervical anastomosis for esophagectomy procedure may reduce the occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.
食管切除术的发病率和死亡率较高。吻合口漏是最常见的并发症，可能是由于吻合口灌注减少所致。此前已对部分患者进行了增压微血管吻合术，以补充食管切除术后移植物和吻合口的血液供应。本研究旨在评估食管切除术中进行增压颈部吻合术后可能出现的并发症。
这项前瞻性对照研究评估了因局部晚期食管癌接受食管切除术并采用胃重建和颈部吻合术的患者。患者被分为两组，第1组采用传统颈部吻合术，第2组采用食管切除术中的增压颈部吻合术进行颈部吻合。在食管切除术中进行增压颈部吻合术前和术后，使用吲哚菁绿和SPY设备（加拿大安大略省多伦多市的Novadaq Technologies公司）评估第2组患者的吻合口灌注区域。还记录了食管切除术后的并发症。
该研究共纳入80例患者，其中男性62例（77.5%），平均年龄64.3岁。第1组和第2组分别有55例和25例患者。第1组和第2组患者的吻合口漏发生率分别为10.5%和0%（P = 0.169），而相应的吻合口狭窄率分别为14.5%和4%（P = 0.260）。灌注分析显示，静脉吻合后吻合口区域的灌注改善了26.5%，动静脉吻合后改善了34.6%。
食管切除术中的增压颈部吻合术可能通过静脉和动脉微血管吻合减少吻合口漏的发生，并改善吻合口区域的灌注。
