Using gastric tube to replace the esophagus has been widely used in esophagectomy. This surgical method is gradually replacing the traditional stomach reconstruction. Its advantages in the incidence of postoperative complication, the quality of life and the long-time survival in clinic have proved to be true. Although using tubular stomach in esophagectomy has become the consensus of experts, some details still need some further discussing and this technique should be gradually improved in future. In this review, the superiority and the technical progress of gastric tube are introduced, and we predict the future of tubular stomach and discuss the existed problems.
ObjectiveTo compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma.MethodsWe selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed.ResultsAmong the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05).ConclusionFor Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.
ObjectiveTo compare clinical outcomes between triluminal-tube feeding combined with tubular stomach and traditional esophagectomy for the treatment of esophageal carcinoma (EC)in elderly patients. MethodsA total of 196 elderly patients (>60 years)with EC who received esophagectomy in the Department of Cardiothoracic Surgery, Mianyang Central Hospital from January 2007 to January 2013 were enrolled in this study. According to different surgical methods, all the patients were divided into triluminal-tube feeding combined with tubular stomach group (group A)and traditional esophagectomy group (group B). There were 96 patients including 51 males and 45 females in group A with their age of 60-81 (66.21±7.32)years, and 100 patients including 54 males and 46 females in group B with their age of 60-82 (65.43±6.37)years. Clinical indexes were compared between the 2 groups. ResultsRadical esophagectomy was successfully performed for all the patients. There was no statistical difference in operation time, intraoperative blood loss, postoperative incidence of chylothorax, recurrent laryngeal nerve paralysis, anastomotic leakage, anastomotic stricture or mortality between the 2 groups (P > 0.05). Time to first passage of flatus and postoperative length of hospital stay of group A were significantly shorter than those of group B, and the incidences of postoperative arrhythmias, pulmonary complications and thoracic-stomach syndrome of group A were significantly lower than those of group B (P < 0.05). ConclusionTriluminal-tube feeding combined with tubular stomach can significantly reduce postoperative morbidity, shorten hospital stay and improve quality of life of elderly patients undergoing esophagectomy.
Esophageal cancer is one of the most common malignant tumors in China. The comprehensive treatment of esophageal cancer based on operation is important. In recent ten years, with the development of surgical techniques and medical instruments, tubular stomach has been widely used. Although the advantages of tubular stomach are becoming more and more obvious, there are still many details and problems for the function and application of tubular stomach worthy of further discussion and study. In this paper, the technical progress, advantages, functions and applications of tubular stomach are reviewed and discussed, and the future prospect is predicted.
Objective To compare short-term quality of life and postoperative complications in esophageal squamous cell carcinoma patients with different routes reconstruction after McKeown esophagectomy. Methods The clinical data of 144 patients with esophageal squamous cell carcinoma who received McKeown esophagectomy in Shanghai Chest Hospital from January 2016 to October 2016 were retrospectively reviewed. Among them 93 patients accepted retrosternal approach (a RR group, 71 males and 22 females at an average age of 63.5±7.7 years) and 51 patients accepted posterior mediastinal approach (a PR group, 39 males and 12 females at an average age of 62.3±8.0 years). Short-term surgical outcomes were compared and a Quality of Life Questionnaire of Patients Underwent Esophagectomy 1.0 was performed at postoperative 1st and 3rd month. Results There was no difference in two groups in sex, age, Body Mass Index (BMI), and location and clinical stage of tumors (P>0.05). The neoadjuvant therapy was more performed in the RR group (16.1%vs. 5.9%, P=0.075). There were more robot-assisted esophagecctomy operations performed in the PR group (52.9% vs. 45.2%, P=0.020). No significant difference was noted in operation duration, intraoperative blood loss or length of ICU stay between the RR and PR groups (251.3±59.1 min vs. 253.1±27.7 min, P=0.862; 223.7±75.1 ml vs. 240.0±75.1 ml, P=0.276; 3.7±6.6 d vs. 2.3±2.1 d, P=0.139). The patients in the PR group had more lymph nodes dissected and shorter hospital stay (P<0.001). Rate of R1/2 resection was higher in the RR group (12.9%vs. 5.9%, P=0.187). No surgery-related mortality was observed in both groups. The anastomotic leak and the anastomotic stricture was higher in the RR group than that in the PR group (25.8% vs. 5.9%, P=0.003). No significant difference was found between the two groups in the quality of life at postoperative 1st and 3rd month. However, the quality of life at postoperative 3rd month significantly improved in both groups (P<0.001). Compared with the PR group, the dysphagia was more severe in the RR group at postoperative 1st month (3.3±1.5 vs. 2.6±1.1, P=0.007), while the reflux symptom was lighter at postoperative 3rd month (3.0±1.8 vs. 3.6±1.6, P=0.045). Conclusion The two different routes reconstruction after McKeown esophagectomy are both safe and feasible. The anterior mediastinal approach increases the risk of anastomotic leak, but with low incidence of reflux symptom.
Objective To summarize the experiences of applying gastric tube in minimally invasive esophagectomy (MIE), in order to assess its feasibility and safety. [WTHZ]Methods From June 2004 to August 2009, MIE was performed on 102 patients with esophageal carcinoma, including 71 males and 31 females whose age ranged from 37 to 79 years old with an average age of 61.1. Among them, 62 patients underwent thoracoscopic laparotomy 3-incision esophagectomy, 35 patients underwent thoracoscopic and laparoscopic 3-incision esophagectomy and 5 patients underwent thoracotomy and laparoscopic esophagectomy. Prevertebral reconstruction was performed on 58 patients and retrosternal reconstruction was performed on 44 patients. [WTHZ]Results All operations were performed successfully with a perioperative mortality rate of 2.0%(2/102) and a postoperative complication rate of 41.2%(42/102). The complications included anastomotic leakage, anastomotic stricture and lung infection. The complication rate was higher in the retrosternal group than in the prevertebral group (56.8% vs. 29.3%, Plt;0.05). Anastomotic leakage rate in the retrosternal group was also higher than that in the prevertebral group (34.1% vs. 6.9%, Plt;0.05). There was no significant difference in anastomotic stenosis, gastric fistula, dysfunction of gastric emptying, heart and lung complications, chylothorax and injury of recurrent laryngeal nerve between the two groups. [WTHZ]Conclusion Gastric tube is an effective way for reconstruction of the digestive tract after minimally invasive esophagectomy. The choice of prevertebral reconstruction or retrosternal reconstruction should be based on each individual patient.
ObjectiveTo investigate the application value of modified gastric tube in surgery for mid- and lowerthoracic esophageal cancer compared with gastric tube. MethodsA total of 221 patients with mid- and lower-thoracic esophageal cancer who underwent esophagectomy between October 2009 and June 2013 in our hospital were recruited in the study. They were randomly divided into a modified gastric tube group (n=108) and a gastric tube group (n=113). There were 67 males and 41 females at age of 63.50±6.75 years (ranged 47-73 years) in the modified gastric tube group, including 62 cases of middle esophageal cancer and 46 cases of lower esophageal cancer. There were 69 males and 44 females at age of 63.38±7.21 years (ranged 49 to 76 years) in the gastric tube group, including 68 cases of middle esophageal cancer and 45 cases of lower esophageal cancer. The results of surgery and morbidities were recorded. The respiratory functions were recorded at 3 days before surgery, 1 week and 4 weeks after surgery, respectively. ResultsAll surgeries were successfully performed in two groups. There was 1 case of death and 1 case of anastomotic leakage in the gastric tube group. There was no death or anastomotic leakage occurred in the modified gastric tube group. There was statistical difference in the operation time between the modified gastric tube group and the gastric tube group (150.65±11.88 min vs. 174.58±11.99 min, P<0.05). There were no statistical differences in the amount of bleeding during operation or the length of hospital stay between two groups (P>0.05). There were no statistical differences in respiratory function between two groups at 1 week or 4 weeks after surgery (P>0.05). ConclusionFor patients with mid- and lower-thoracic esophageal cancer, modified gastric tube has a good clinical application value compared with gastric tube. It is easy and safe, and can decrease the operation time without aggravation of pulmonary function after operation. It is a better esophagus reconstruction method in esophagectomy for mid- and lower-thoracic esophageal cancer in primary hospitals.
ObjectiveTo compare the clinical efficacy of cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis and conventional tubular stomach combined with neck end-to-end mechanical side-to-side anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. MethodsThe clinical data of consecutive patients treated by thoracoscopic and laparoscopic esophagectomy for esophageal cancer in the Department of Cardiothoracic Surgery of the First People's Hospital of Neijiang from January 1, 2018 to March 25, 2021 were analyzed. The patients were divided into a cone-shaped gastric tube manual group (treated with cone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis) and a conventional tubular stomach mechanical group (treated with conventional tubular stomach+end-to-end mechanical side-to-side anastomosis). The anastomotic time, intraoperative blood loss, number of lymph node dissection, anastomotic fistula, anastomotic stenosis, anastomotic cost, sternogastric dilatation, gastroesophageal reflux symptoms, and postoperative complications were compared and analyzed between the two groups. ResultsA total of 161 patients were enrolled, including 112 males and 49 females aged 40-82 years. There were 80 patients in the cone-shaped gastric tube manual group, and 81 patients in the conventional tubular stomach mechanical group. There was no statistical difference in the intraoperative blood loss, number of lymph nodes dissected, hoarseness, pulmonary infection, arrhythmia, respiratory failure or chylothorax between the two groups (P>0.05). The anastomosis time of the cone-shaped gastric tube manual group was longer than that of the conventional tubular stomach mechanical group (28.35±3.20 min vs. 14.30±1.26 min, P<0.001), but the anastomotic cost and incidence of thoracogastric dilatation in the cone-shaped gastric tube manual group were significantly lower than those of the conventional tubular stomach mechanical group [948.48±70.55 yuan vs. 4 978.76±650.29 yuan, P<0.001; 3 (3.8%) vs. 14 (17.3%), P=0.005]. The incidences of anastomotic fistula and anastomotic stenosis in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group, but the differences were not statistically significant (P>0.05). The gastroesophageal reflux scores in the cone-shaped gastric tube manual group were lower than those in the conventional tubular gastric mechanical group at 1 month, 3 months, 6 months and 1 year after the operation (P<0.05). Logistic regression analysis showed that digestive tract reconstruction method was the influencing factor for postoperative thoracogastric dilation, which was reduced in the cone-shaped gastric tube manual group. ConclusionCone-shaped gastric tube combined with cervical end-to-end stratified manual anastomosis can significantly reduce the incidence of thoracogastric dilatation after thoracoscopic and laparoscopic esophagectomy for esophageal cancer and save hospitalization costs, with mild gastroesophageal reflux symptoms, and it still has certain advantages in reducing postoperative anastomotic fistula and anastomotic stenosis, which is worthy of clinical promotion.
Abstract: Objective To Evaluate the clinical outcome of gastric tube in radical surgeries to treat esophageal and cardial carcinoma. Methods From January to October 2008, 74 patients with esophageal or cardial carcinoma in Ruijin Hospital were enrolled in our study. Based on the surgical method, they were divided into the gastric tube group and the traditional way group. The gastric tube group had 46 patients, including 36 male patients and 10 female patients, whose age averaged 59.67±9.96 years (36 to 77 years). Among them, 31 patients had esophageal carcinoma with 1 upper, 23 middle and 7 lower esophageal carcinoma, and 15 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck, 19 with anastomosis in the upper aortic arch, 10 with anastomosis in the lower aortic arch and 15 cardial carcinoma patients underwent radical resection. In the traditional way group, there were 28 patients, 25 male patients and 3 female patients, whose age averaged 59.17±11.33 years (37 to 86 years). In these patients, 22 had esophageal carcinoma with 1 in the upper esophagus, 17 in the middle esophagus, 4 in the lower esophagus; and 6 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck , 17 with anastomosis in the upper aortic arch, 3 with anastomosis in the lower aortic arch, and 6 cardial carcinoma patients underwent radical resection. The rate of anastomotic leakage, operation time, and length of stay in hospital of these two groups were observed. Results All surgeries in the two groups were successfully performed. There was no anastomotic leakage case in the gastric tube group, while there were 4 pulmonary infection cases and 1 death case in the traditional way group. There was no statistically difference in the operation time (180.00±10.34 min vs. 185.00±6.23 min, t=1.669, P=0.078) and length of stay in hospital (16.78±9.98 d vs. 16.89±11.53 d, t=1.665, P=0.075) between the gastric tube group and the traditional way group. Conclusion Gastric tube has a good value in clinical application with fewercomplications and without prolonging operation and hospitalization time, which can surely better quality of life of the patients.