Ma Minjie, Xu Shangqing, Han Biao, Wei Ning, Liu Lixin, Lin Ruijiang, Hu Wenteng, Yue Peng, Cao Xiong, Wang Hongbing, He Hua, Ma Xiang, Han Zhiwei
Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
J Gastrointest Oncol. 2023 Apr 29;14(2):544-553. doi: 10.21037/jgo-23-166. Epub 2023 Apr 14.
Esophageal cancer (EC) is one of the most common malignant tumor types. Surgery is considered the treatment of choice for patients with early- and mid-stage EC. However, because of the traumatic nature of EC surgery and the need for gastrointestinal reconstruction, high rates of postoperative complications such as anastomotic leakage or stenosis, esophageal reflux, and pulmonary infection exist. Its time to explore a novel esophagogastric anastomosis method for McKeown EC surgery to reduce the postoperative complication.
This study recruited a total of 544 patients who underwent McKeown resection for EC between January 2017 and August 2020. The tubular stapler-assisted nested anastomosis was taken as the time node, including 212 patients in the traditional tubular mechanical anastomosis group and 332 patients in the tubular stapler-assisted nested anastomosis group. The 6-month postoperative incidence of anastomotic fistula and anastomotic stenosis was recorded. Anastomosis in McKeown operation for EC and the influence of different anastomosis methods on clinical efficacy were investigated.
Compared with traditional mechanical anastomosis, tubular stapler-assisted nested anastomosis had a lower incidence of anastomotic fistula (0% 5.2%), lung infection (3.3% 11.8%), gastroesophageal reflux (6.9% 16.0%), anastomotic stenosis (3.0% 10.4%), neck incision infection (0.9% 7.1%), anastomositis (16.6% 23.6%), and a shorter surgical duration (11.02±1.54 18.53±3.20 min). Statistical significance was indicated at P<0.05. No significant difference was detected in the incidence of arrhythmia, recurrent laryngeal nerve injury, or chylothorax between the 2 groups. Due to its good effect in McKeown surgery for EC, stapler-assisted nested anastomosis has been widely used in McKeown surgery for EC, and has become a common anastomosis method in our department for McKeown surgery for EC. However, large sample-sized studies and long-term efficacy observation are still needed.
The use of tubular stapler-assisted nested anastomosis can significantly reduce the incidence of complications such as anastomotic fistula, anastomotic stricture, gastroesophageal reflux, and pulmonary infection; therefore, it constitutes the preferred technique for cervical anastomosis in McKeown esophagogastrectomy.
食管癌（EC）是最常见的恶性肿瘤类型之一。手术被认为是早期和中期EC患者的首选治疗方法。然而，由于EC手术具有创伤性且需要进行胃肠道重建，术后并发症发生率较高，如吻合口漏或狭窄、食管反流和肺部感染。是时候探索一种新的食管胃吻合方法用于McKeown食管癌手术以减少术后并发症了。
本研究共纳入了2017年1月至2020年8月期间接受McKeown食管癌切除术的544例患者。以管状吻合器辅助套叠吻合为时间节点，其中传统管状机械吻合组212例患者，管状吻合器辅助套叠吻合组332例患者。记录术后6个月吻合口瘘和吻合口狭窄的发生率。研究EC的McKeown手术中的吻合方式以及不同吻合方式对临床疗效的影响。
与传统机械吻合相比，管状吻合器辅助套叠吻合的吻合口瘘发生率较低（0%对5.2%）、肺部感染发生率较低（3.3%对11.8%）、胃食管反流发生率较低（6.9%对16.0%）、吻合口狭窄发生率较低（3.0%对10.4%）、颈部切口感染发生率较低（0.9%对7.1%）、吻合口炎发生率较低（16.6%对23.6%），且手术时间较短（11.02±1.54对18.53±3.20分钟）。P<0.05表示差异有统计学意义。两组在心律失常、喉返神经损伤或乳糜胸发生率方面未检测到显著差异。由于其在EC的McKeown手术中效果良好，吻合器辅助套叠吻合已广泛应用于EC的McKeown手术中，并已成为我科EC的McKeown手术中常用的吻合方法。然而，仍需要大样本研究和长期疗效观察。
使用管状吻合器辅助套叠吻合可显著降低吻合口瘘、吻合口狭窄、胃食管反流和肺部感染等并发症的发生率；因此，它是McKeown食管胃切除术中颈部吻合的首选技术。
