Chen Xinhua, Yang Zhijing, Huang Huilin, Xu Chuanjin, Li Guoxin, Hu Yanfeng, Lin Tian, Yu Jiang
Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
Southern Medical University Nanfang Hospital, Guangzhou, China.
Ann Surg Oncol. 2025 Apr 29. doi: 10.1245/s10434-025-17302-z.
Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy.
We aimed to compare the safety and efficacy of a novel technique, the JNT, with traditional nasogastric tubing (TNT) in guiding OGT-overlap esophagojejunostomy.
From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; n = 53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; n = 53).
The JNT group had a significantly higher success rate for nasogastric tube (NT) insertion into the esophageal stump on the first attempt (90.6% vs. 58.5%; p < 0.001). Additionally, the insertion times were reduced by 6/7 of their original duration (15 [21] vs. 100 [120] sec; p < 0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration (90 [63] vs. 220 [130] sec; p < 0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; p < 0.001). Two cases were converted from TNT to JNT due to the failure of TNT to guide the esophageal stump entry hole for more than 5 min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; p = 0.807), particularly esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; p =1.000), and complication severity classification (p = 0.315) were comparable between the two groups.
The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.
我们的团队率先在重叠式食管空肠吻合术引导管（OGT）的重叠式食管空肠吻合术中使用联合鼻胃管（JNT），证明了其安全性和有效性。
我们旨在比较一种新技术JNT与传统鼻胃管（TNT）在引导OGT重叠式食管空肠吻合术中的安全性和有效性。
2023年1月至2024年1月，共有108例接受腹腔镜全胃切除术（LTG）的胃/胃食管交界（G/GEJ）癌患者符合纳入本研究的条件；然而，有2例患者因术后接受了腹腔内热化疗（HIPEC）而被排除。患者被随机分为两组：JNT-OGT重叠式食管空肠吻合术组（JNT组；n = 53）或TNT-OGT重叠式食管空肠吻合术组（TNT组；n = 53）。
JNT组首次尝试将鼻胃管（NT）插入食管残端的成功率显著更高（90.6%对58.5%；p < 0.001）。此外，插入时间减少了原时长的6/7（15 [21]对100 [120]秒；p < 0.001），OGT与NT的连接时间缩短至原时长的2/5（90 [63]对220 [130]秒；p < 0.001）。JNT组的食管空肠吻合时间也更短（17.4对21.7分钟；p < 0.001）。有2例因TNT无法引导食管残端入口孔超过5分钟而从TNT转换为JNT，JNT迅速解决了该问题。两组术后并发症（18.9%对20.8%；p = 0.807），尤其是食管空肠吻合口漏（EJAL；5.7%对3.8%；p = 1.000）以及并发症严重程度分级（p = 0.315）相当。
与TNT相比，JNT技术显著且安全地提高了OGT重叠式食管空肠吻合术的效率，表明这是一种耐受性良好且高效的食管空肠吻合新策略。
