Lin Hang, Liang Ge'ao, Chai Huiping, Liao Yongde, Zhang Chunfang, Cheng Yuanda
Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, China.
Department of Oncology, National Health Commission (NHC) Key Laboratory of Cancer Proteomics, Xiangya Hospital, Central South University, Changsha, China.
Front Oncol. 2021 Dec 16;11:759599. doi: 10.3389/fonc.2021.759599. eCollection 2021.
The optimal technique for the thoracoscopic construction of an intrathoracic esophagogastric anastomosis continues to be a subject of controversy. The aim of this study was to compare the perioperative outcomes of circular-stapled anastomosis using a transorally inserted anvil (Orvil™) with those of circular-stapled anastomosis using a transthoracically placed anvil (non-Orvil™) in totally minimally invasive Ivor Lewis esophagectomy (Ivor Lewis TMIE).
The data of 272 patients who underwent Ivor Lewis TMIE for esophageal cancer at multiple centers were collected from January 1, 2014 to December 31, 2017. After propensity score matching (1:1) for patient baseline characteristics, 65 paired cases were selected for statistical analysis. Logistic regression analysis was performed to investigate the significant factors of anastomotic leakage.
In the propensity score-matched analysis, compared with the non-Orvil™ group, the Orvil™ group was associated with a significantly shorter operation time (=0.031), less intraoperative hemorrhage (<0.001), lower need for intraoperative transfusions (=0.009), earlier postoperative oral feeding time (=0.010), longer chest tube duration (<0.001), shorter postoperative hospital stays (=0.001), lower total hospitalization costs (<0.001) and a lower postoperative anastomotic leakage rate (=0.033). Multivariate logistic regression analysis showed that anastomotic technique and pulmonary infection were independent factors for the development of postoperative anastomotic leakage (< 0.05).
Orvil™ anastomosis exhibited better perioperative effects than non-Orvil™ anastomosis after the propensity score-matched analysis. Remarkably, the Orvil™ technique contributed to a lower postoperative anastomotic leakage rate than the non-Orvil™ technique.
胸腔镜下胸段食管胃吻合的最佳技术仍是一个有争议的话题。本研究的目的是比较在完全微创的Ivor Lewis食管癌切除术（Ivor Lewis TMIE）中，使用经口插入吻合器砧座（Orvil™）进行圆形吻合与使用经胸放置吻合器砧座（非Orvil™）进行圆形吻合的围手术期结果。
收集2014年1月1日至2017年12月31日期间在多个中心接受Ivor Lewis TMIE治疗食管癌的272例患者的数据。在对患者基线特征进行倾向评分匹配（1:1）后，选择65对病例进行统计分析。进行逻辑回归分析以研究吻合口漏的相关因素。
在倾向评分匹配分析中，与非Orvil™组相比，Orvil™组手术时间显著缩短（=0.031），术中出血更少（<0.001），术中输血需求更低（=0.009），术后经口进食时间更早（=0.010），胸腔引流管留置时间更长（<0.001），术后住院时间更短（=0.001），总住院费用更低（<0.001），术后吻合口漏率更低（=0.033）。多因素逻辑回归分析显示，吻合技术和肺部感染是术后吻合口漏发生的独立因素（<0.05）。
倾向评分匹配分析后，Orvil™吻合术的围手术期效果优于非Orvil™吻合术。值得注意的是，Orvil™技术导致的术后吻合口漏率低于非Orvil™技术。
