Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
J Gastrointest Surg. 2022 Apr;26(4):725-732. doi: 10.1007/s11605-022-05266-4. Epub 2022 Feb 9.
This study was performed to verify the superiority of a new "non-tensioning method" for avoiding stricture of the cervical esophagogastric anastomosis by circular stapling compared with the conventional method.
In total, 395 consecutive patients who underwent McKeown esophagectomy with gastric conduit (GC) reconstruction were reviewed. A 4 cm-wide GC was created and pulled up at the cervical site through the retrosternal route. The esophagogastrostomy site of the GC was planned as far caudally as possible on the greater curvature side. In the conventional technique, the stapler was fired while pulling the GC to avoid tissue slack. In the non-tensioning technique, the stapler was fired through the natural thickness of the stomach wall. The length of the blind end was changed from 4 to 2 cm in the non-tensioning technique. Anastomotic leakage and stricture formation were compared between the two techniques, and adjustment was performed using propensity score matching.
The conventional group comprised 315 patients, and the non-tensioning group comprised 80 patients. Anastomotic leakage occurred in 22 (7%) and 2 (2.5%) patients, respectively (P = 0.134) [and in 9 (2.9%) and 2 (2.5%) patients, respectively, if leakage at the blind end was excluded]. Anastomotic stricture occurred in 92 (29.2%) and 3 (3.8%) patients, respectively (P < 0.001). The propensity score-matching analysis including 79 pairs of patients confirmed a lower stricture rate in the non-tensioning than conventional group (2.5% vs. 29.1%, P < 0.001).
The non-tensioning technique significantly reduced the incidence of anastomotic stricture compared with the conventional technique.
本研究旨在验证一种新的“非张力方法”在通过圆形吻合器避免颈段食管胃吻合口狭窄方面优于传统方法。
共回顾了 395 例接受 McKeown 食管癌根治术和胃管（GC）重建的连续患者。创建了一个 4cm 宽的 GC，并通过胸骨后途径向上拉至颈部。GC 的食管胃吻合部位尽可能位于胃大弯侧的远端。在传统技术中，在拉动 GC 时击发吻合器以避免组织松弛。在非张力技术中，吻合器通过胃壁的自然厚度击发。非张力技术中盲端的长度从 4cm 变为 2cm。比较两种技术的吻合口漏和狭窄形成，并使用倾向评分匹配进行调整。
传统组包括 315 例患者，非张力组包括 80 例患者。吻合口漏发生在 22 例（7%）和 2 例（2.5%）患者中（P=0.134）[如果排除盲端漏，则分别为 9 例（2.9%）和 2 例（2.5%）]。吻合口狭窄发生在 92 例（29.2%）和 3 例（3.8%）患者中（P<0.001）。包括 79 对患者的倾向评分匹配分析证实，非张力组的吻合口狭窄发生率低于传统组（2.5%比 29.1%，P<0.001）。
与传统技术相比，非张力技术显著降低了吻合口狭窄的发生率。
