Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
BMC Surg. 2022 Jul 2;22(1):255. doi: 10.1186/s12893-022-01704-x.
This retrospective study aimed to investigate the short-term surgical outcomes and nutritional status of ileo-colon interposition in patients with esophageal cancer who could not undergo gastric tube reconstruction.
Sixty-four patients underwent subtotal esophagectomy with reconstruction using ileo-colon interposition for esophageal cancer at the Wakayama Medical University Hospital between January 2001 and July 2020. Using propensity scores to strictly balance the significant variables, we compared treatment outcomes.
Before matching, 18 patients had cologastrostomy and 46 patients had colojejunostomy. After matching, we enrolled 34 patients (n = 17 in cologastrostomy group, n = 17 in colojejunostomy group). Median operation time in the cologastrostomy group was significantly shorter than that in the colojejunostomy group (499 min vs. 586 min; P = 0.013). Perforation of the colon graft was observed in three patients (7%) and colon graft necrosis was observed in one patient (2%) in the gastrojejunostomy group. Median body weight change 1 year after surgery in the cologastrostomy group was significantly less than that of the colojejunostomy group (92.9% vs. 88.5%; P = 0.038). Further, median serum total protein level 1 year after surgery in the cologastrostomy group was significantly higher than that of the colojejunostomy group (7.0 g/dL vs. 6.6 g/dL, P = 0.030).
Subtotal esophagectomy with reconstruction using ileo-colon interposition is a safe and feasible procedure for the patients with esophageal cancer in whom gastric tubes cannot be used. Cologastrostomy with preservation of the remnant stomach had benefits in the surgical outcomes and the postoperative nutritional status.
本回顾性研究旨在探讨无法进行胃管重建的食管癌患者行结肠间置术的短期手术结果和营养状况。
2001 年 1 月至 2020 年 7 月，我院共有 64 例食管癌患者行次全食管切除术，采用结肠间置术重建食管。采用倾向评分严格平衡显著变量，比较两组患者的治疗结果。
在匹配前，18 例患者行结肠胃吻合术，46 例行结肠空肠吻合术。匹配后，我们共纳入 34 例患者（结肠胃吻合术组 17 例，结肠空肠吻合术组 17 例）。结肠胃吻合术组的中位手术时间明显短于结肠空肠吻合术组（499 分钟比 586 分钟；P=0.013）。胃空肠吻合术组中有 3 例（7%）发生结肠移植物穿孔，1 例（2%）发生结肠移植物坏死。结肠胃吻合术组术后 1 年体重变化中位数明显小于结肠空肠吻合术组（92.9%比 88.5%；P=0.038）。此外，结肠胃吻合术组术后 1 年血清总蛋白水平中位数明显高于结肠空肠吻合术组（7.0 g/dL 比 6.6 g/dL；P=0.030）。
对于无法使用胃管的食管癌患者，次全食管切除术联合结肠间置术是一种安全可行的手术方法。保留残胃的结肠胃吻合术在手术结果和术后营养状况方面具有优势。
