Nakamura Kenichi, Suda Koichi, Akamatsu Hokuto, Shibasaki Susumu, Nakauchi Masaya, Kikuchi Kenji, Kadoya Shinichi, Inaba Kazuki, Uyama Ichiro
Division of Upper GI, Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Fujita Med J. 2019;5(2):36-44. doi: 10.20407/fmj.2018-011. Epub 2019 Feb 6.
Anastomotic leak is a common complication after esophagectomy for esophageal cancer. This study evaluated the impact of the Kocher maneuver on the incidence of anastomotic leak following esophagogastrostomy using a 3-cm-wide gastric conduit.
This single-institution, retrospective, cohort study included 43 patients who underwent thoraco-laparoscopic esophagectomy. The Kocher maneuver was not performed in the first half of the study period between April 2014 and May 2015 (first half group, n=14), but was performed in the second half between May 2015 and January 2017 (second half group, n=29). Primary endpoint was the incidence of anastomotic leak. Metrological values of the gastric conduit were postoperatively assessed on computed tomography. Blood perfusion of the gastric conduit was prospectively examined using the indocyanine green fluorescence method.
The incidence of anastomotic leak was 14%; the incidence was significantly lower in the second half group than in the first half group (3.4% vs. 35.7%, p=0.01). The Kocher maneuver was the only significant independent risk factor associated with anastomotic leak (OR 0.064, 95% CI 0.007-0.625, p=0.018). The postoperative length of the entire gastric conduit was significantly shorter in the second half group than in the first half group. A more anal location of the 3-cm-wide gastric conduit was associated with better blood perfusion.
The Kocher maneuver may enable shortening of the gastric conduit, leading to better blood perfusion of the tip of the gastric conduit, and a significant reduction in the occurrence of anastomotic leak.
吻合口漏是食管癌食管切除术后的常见并发症。本研究评估了 Kocher 手法对使用 3 厘米宽胃管道进行食管胃吻合术后吻合口漏发生率的影响。
这项单机构、回顾性队列研究纳入了 43 例行胸腹腔镜食管切除术的患者。在 2014 年 4 月至 2015 年 5 月的研究上半年（上半年组，n = 14）未进行 Kocher 手法，但在 2015 年 5 月至 2017 年 1 月的下半年（下半年组，n = 29）进行了 Kocher 手法。主要终点是吻合口漏的发生率。术后通过计算机断层扫描评估胃管道的测量值。使用吲哚菁绿荧光法前瞻性检查胃管道的血液灌注。
吻合口漏的发生率为 14%；下半年组的发生率显著低于上半年组（3.4% 对 35.7%，p = 0.01）。Kocher 手法是与吻合口漏相关的唯一显著独立危险因素（OR 0.064，95% CI 0.007 - 0.625，p = 0.018）。下半年组整个胃管道的术后长度明显短于上半年组。3 厘米宽胃管道位置越靠下，血液灌注越好。
Kocher 手法可能使胃管道缩短，导致胃管道末端血液灌注更好，并显著降低吻合口漏的发生率。
