Comparison of the Influence of Intrathoracic and Retrosternal Esophagogastric Anastomosis on Pulmonary Function in Aged Patients after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOUZhi-ming , WANGZe-xue , LIUYong-xin , LIANGLei

Department of Thoracic Surgery, Fengtian Hospital, Shenyang Medical College, Shenyang 110024, P. R. China;

Corresponding?author：

ZHOUZhi-ming, Email: ftyyxwk@163.com

Keywords：

Aged; Esophageal carcinoma; Intrathoracic esophagogastric anastomosis; Retrosternal esophago-gastric anastomosis; Pulmonary function

DOI：

10.7507/1007-4848.20140139

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Objective To compare the influence of intrathoracic and retrosternal esophagogastric anastomosis on pulmonary function in aged patients after esophagectomy. Methods Forty patients (older than 62 years) with upper or middle thoracic esophageal carcinoma (EC) who underwent esophagectomy in Fengtian Hospital of Shenyang Medical College between February 2009 and May 2011 were enrolled in this study. According to different surgical approach, all the patients were divided into an intrathoracic esophagogastric anastomosis (IEGA) group and a retrosternal esophagogastric anastomosis (REGA) group. There were 20 patients in IEGA group including 16 males and 4 females with their age of 62-79 (64.70±11.47) years, who received cervical anastomosis after EC resection and intrathoracic gastric tube reconstruction. There were 20 patients in REGA group including 17 males and 3 females with their age of 63-77 (65.90±12.72) years, who received cervical anastomosis after EC resection and retrosternal gastric tube reconstruction. Pulmonary function test (PFT) was performed preoperatively and on the 15th and 30th postoperative day, and compared between the 2 groups. Results There was no statistical difference in preoperative PFT between the 2 groups (P > 0.05). PFT of IEGA group on the 15th and 30th postoperative day was significantly worse than preoperative PFT (P < 0.05). PFT of REGA group on the 15th and 30th postoperative day was not statistically different from preoperative PFT (P > 0.05). PFT of REGA group on the 15th and 30th postoperative day was significantly better than PFT of IEGA group (P < 0.05). In IEGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, pneumonia in 5 patients and atelectasis in 1 patient. In REGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, gastric outlet obstruction in 1 patient and pneumonia in 3 patients. All the patients were followed up for 1 year. There was no statistical difference between PFT at 1 year after discharge and PFT on the 30th postoperative day in either group. Conclusions IEGA can significantly reduce postoperative PFT. REGA has less negative influence on postoperative PFT, is suitable for aged patients and patients with unsatisfactory preoperative PFT, can reduce postoperative complications and improve postoperative quality of life.

Citation： ZHOUZhi-ming, WANGZe-xue, LIUYong-xin, LIANGLei. Comparison of the Influence of Intrathoracic and Retrosternal Esophagogastric Anastomosis on Pulmonary Function in Aged Patients after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 490-493. doi: 10.7507/1007-4848.20140139 Copy

1.	齊戰, 朱德成, 陳萬生, 等.胸骨后胃對食管癌圍手術期呼吸功能的影響.中華胸心血管外科雜志, 2000, 16 (3):26-28.
2.	黃建家, 付俊慧, 王衛光, 等.管狀胃代食管對食管癌術后肺功能的影響.臨床和實驗醫學雜志, 2008, 10 (7):29-30.
3.	Berkow R, 主編.默克診療手冊.第15版.北京:人民衛生出版社, 1992. 587.
4.	Jiao WJ, Wang TY, Gong M, et al. Pulmonary complications in patients with chronic obstructive pulmonary disease following trans-thoracic esophagectomy. World J Gastroenterol, 2006, 12 (16):2505-2509.
5.	郭偉, 蔣耀光, 王知文, 等.不同術式食管癌根治術前后患者肺功能情況研究.局解手術學雜志, 2009, 18 (2):96-98.
6.	馮曉祥, 王群, 蔣偉, 等.食管切除術后管狀胃不同上提路徑的比較.中華胃腸外科雜志, 2010, 13 (1):33-35.
7.	Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up:the effect of the route of reconstruction. World J Surg, 2005, 29 (2):174-181.
8.	Kato H, Miyazaki T, Sakai M, et al. Videofluoroscopic evaluation in oropharyngeal swallowing after radical esophagectomy with lympha-denectomy for esophageal cancer. Anticancer Res, 2007, 27 (6C):4249-4254.
9.	毛友生, 張汝剛, 孫莉, 等.食管癌病人術前肺功能與全麻開胸狀態下氣道阻力相關性的研究.中華胸心血管外科雜志, 1999, 15 (4):222-224.
10.	李勇, 施鞏寧, 馬紅冰, 等.管狀胃對食管癌術后圍術期呼吸功能的影響.臨床醫學, 2010, 30 (5):61-62.
11.	馮剛, 甘崇志, 叢偉, 等.兩種弓上吻合途徑對食管胸中段癌患者術后肺功能的影響.華西醫學, 2003, 18 (1):12-13.
12.	郭海周, 王建軍, 周福有, 等.管狀胃對食管癌切除術后并發癥的改善作用.中華胃腸外科雜志, 2010, 14 (1):65-66.
13.	劉穎珍, 肖慶隆, 徐波, 等.胸部腫瘤病人圍手術期血氣監測及臨床意義.中華胸心血管外科雜志, 1994, 10 (3):220-222.
14.	武新慧, 張玉想, 胡震杰, 等.食管癌術后嚴重并發癥臨床分析及對策.河北醫科大學學報, 2008, 29 (5):668-671.
15.	伍傳新, 陳樹群, 林昱, 等.管狀胃經食管床弓上吻合術對食管癌術后肺功能的影響.中華胃腸外科雜志, 2010, 13 (6):450-451.
16.	陳萬生, 劉艷慧, 南茹, 等.食管癌術后的呼吸功能.中華胸心血管外科雜志, 2007, 23 (5):317-319.
17.	何丹, 韓峰, 張國慶, 等.管狀胸腔胃對食管癌根治術后患者生活質量的影響.中華胃腸外科雜志, 2011, 14 (9):728-729.
18.	Maruyamrk, Kitymura M, Izumi K, et al. Postoperative lung volume calculated by chest computed tompgraphy in patients with esophageal cancer. Jpn Thorac Cardiovasc Surg, 1999, 47 (5):193-198.
19.	Morita M, Egashira A, Yoshida R, et al. Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus. J Gastroenterol, 1999, 43 (5):345-351.
20.	車嘉銘, 項捷, 陳凱, 等.管狀胃在食管、賁門癌手術中的臨床應用.中國胸心血管外科臨床雜志, 2010, 17 (2):96-98.

1. 齊戰, 朱德成, 陳萬生, 等.胸骨后胃對食管癌圍手術期呼吸功能的影響.中華胸心血管外科雜志, 2000, 16 (3):26-28.
2. 黃建家, 付俊慧, 王衛光, 等.管狀胃代食管對食管癌術后肺功能的影響.臨床和實驗醫學雜志, 2008, 10 (7):29-30.
3. Berkow R, 主編.默克診療手冊.第15版.北京:人民衛生出版社, 1992. 587.
4. Jiao WJ, Wang TY, Gong M, et al. Pulmonary complications in patients with chronic obstructive pulmonary disease following trans-thoracic esophagectomy. World J Gastroenterol, 2006, 12 (16):2505-2509.
5. 郭偉, 蔣耀光, 王知文, 等.不同術式食管癌根治術前后患者肺功能情況研究.局解手術學雜志, 2009, 18 (2):96-98.
6. 馮曉祥, 王群, 蔣偉, 等.食管切除術后管狀胃不同上提路徑的比較.中華胃腸外科雜志, 2010, 13 (1):33-35.
7. Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up:the effect of the route of reconstruction. World J Surg, 2005, 29 (2):174-181.
8. Kato H, Miyazaki T, Sakai M, et al. Videofluoroscopic evaluation in oropharyngeal swallowing after radical esophagectomy with lympha-denectomy for esophageal cancer. Anticancer Res, 2007, 27 (6C):4249-4254.
9. 毛友生, 張汝剛, 孫莉, 等.食管癌病人術前肺功能與全麻開胸狀態下氣道阻力相關性的研究.中華胸心血管外科雜志, 1999, 15 (4):222-224.
10. 李勇, 施鞏寧, 馬紅冰, 等.管狀胃對食管癌術后圍術期呼吸功能的影響.臨床醫學, 2010, 30 (5):61-62.
11. 馮剛, 甘崇志, 叢偉, 等.兩種弓上吻合途徑對食管胸中段癌患者術后肺功能的影響.華西醫學, 2003, 18 (1):12-13.
12. 郭海周, 王建軍, 周福有, 等.管狀胃對食管癌切除術后并發癥的改善作用.中華胃腸外科雜志, 2010, 14 (1):65-66.
13. 劉穎珍, 肖慶隆, 徐波, 等.胸部腫瘤病人圍手術期血氣監測及臨床意義.中華胸心血管外科雜志, 1994, 10 (3):220-222.
14. 武新慧, 張玉想, 胡震杰, 等.食管癌術后嚴重并發癥臨床分析及對策.河北醫科大學學報, 2008, 29 (5):668-671.
15. 伍傳新, 陳樹群, 林昱, 等.管狀胃經食管床弓上吻合術對食管癌術后肺功能的影響.中華胃腸外科雜志, 2010, 13 (6):450-451.
16. 陳萬生, 劉艷慧, 南茹, 等.食管癌術后的呼吸功能.中華胸心血管外科雜志, 2007, 23 (5):317-319.
17. 何丹, 韓峰, 張國慶, 等.管狀胸腔胃對食管癌根治術后患者生活質量的影響.中華胃腸外科雜志, 2011, 14 (9):728-729.
18. Maruyamrk, Kitymura M, Izumi K, et al. Postoperative lung volume calculated by chest computed tompgraphy in patients with esophageal cancer. Jpn Thorac Cardiovasc Surg, 1999, 47 (5):193-198.
19. Morita M, Egashira A, Yoshida R, et al. Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus. J Gastroenterol, 1999, 43 (5):345-351.
20. 車嘉銘, 項捷, 陳凱, 等.管狀胃在食管、賁門癌手術中的臨床應用.中國胸心血管外科臨床雜志, 2010, 17 (2):96-98.

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Comparison of the Influence of Intrathoracic and Retrosternal Esophagogastric Anastomosis on Pulmonary Function in Aged Patients after Esophagectomy

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