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.
Objective
To explore the feasibility of single mediastinal drainage tube in treatment of esophageal carcinoma after thoracoscopic combined with laparoscopic surgery.
Methods
There were 90 esophagus cancer patients treated by surgery in our hospital between June 2015 and October 2016. The patients were allocated into two groups including a single-drainage tube group and a two-drainage tube group. There were 45 patients with 24 males and 21 females at age of 48-78 years in the two-drainage tube group and 45 patients with 23 males and 22 females at age of 45-84 years in the single-drainage tube group.The clinical effect of the two groups was compared.
Results
There was no statistical difference in gender and age, bleeding amount and surgical duration in operation, thoracic drainage amount, incidence of atelectasis, pneumothorax, and encapsulated effusion between the two groups(P<0.05).
Discussion
Single-drainage tube group displays less postoperative pain, faster recovery, and more convenient clinical care without complication.
ObjectiveTo compare the surgical efficacy of Da Vinci robot-assisted minimally invasive esophagectomy (RAMIE) and video-assisted minimally invasive esophagectomy (VAMIE) on esophageal cancer.MethodsOnline databases including PubMed, the Cochrane Library, Medline, EMbase and CNKI from inception to 31, December 2019 were searched by two researchers independently to collect the literature comparing the clinical efficacy of RAMIE and VAMIE on esophageal cancer. Newcastle-Ottawa Scale was used to assess quality of the literature. The meta-analysis was performed by RevMan 5.3.ResultsA total of 14 studies with 1 160 patients were enrolled in the final study, and 12 studies were of high quality. RAMIE did not significantly prolong total operative time (P=0.20). No statistical difference was observed in the thoracic surgical time through the McKeown surgical approach (MD=3.35, 95%CI –3.93 to 10.62, P=0.37) or in surgical blood loss between RAMIE and VAMIE (MD=–9.48, 95%CI –27.91 to 8.95, P=0.31). While the RAMIE could dissect more lymph nodes in total and more lymph nodes along the left recurrent laryngeal recurrent nerve (MD=2.24, 95%CI 1.09 to 3.39, P=0.000 1; MD=0.89, 95%CI 0.13 to 1.65, P=0.02) and had a lower incidence of vocal cord paralysis (RR=0.70, 95%CI 0.53 to 0.92, P=0.009).ConclusionThere is no statistical difference observed between RAMIE and VAMIE in surgical time and blood loss. RAMIE can harvest more lymph nodes than VAMIE, especially left laryngeal nerve lymph nodes. RAMIE shows a better performance in reducing the left laryngeal nerve injury and a lower rate of vocal cord paralysis compared with VAMIE.
ObjectiveTo compare the efficacy of mediastinoscope-assisted transhiatal esophagectomy (MATHE) and functional minimally invasive esophagectomy (FMIE) for esophageal cancer. MethodsPatients who underwent minimally invasive esophagectomy at Jining No.1 Hospital from March 2018 to September 2022 were retrospectively included. The patients were divided into a MATHE group and a FMIE group according to the procedures. The patients were matched via propensity score matching (PSM) with a ratio of 1 : 1 and a caliper value of 0.2. The clinical data of the patients were compared after the matching. ResultsA total of 73 patients were include in the study, including 54 males and 19 females, with an average age of (65.12±7.87) years. There were 37 patients in the MATHE group and 36 patients in the FMIE group. Thirty pairs were successfully matched. Compared with the FMIE group, MATHE group had shorter operation time (P=0.022), lower postoperative 24 h pain score (P=0.031), and less drainage on postoperative 1-3 days (P<0.001). FMIE group had more lymph node dissection (P<0.001), lower incidence of postoperative hoarseness (P=0.038), lower white blood cell and neutrophil counts on postoperative 1 day (P<0.001). There was no statistically significant difference in the bleeding volume, R0 resection, hospital mortality, postoperative hospital stay, anastomotic leak, chylothorax, or pulmonary infection between the two groups (P>0.05). ConclusionCompared with the FMIE, MATHE has shorter operation time, less postoperative pain and drainage, but removes less lymph nodes, which is deficient in oncology. For some special patients such as those with early cancer or extensive pleural adhesions, MATHE may be a suitable surgical method.
Abstract： Objective To investigate the clinical application of tubular stomach in cervical esophageal reconstruction after esophagectomy for esophageal cancer. Methods A total of 850 patients with esophageal cancer who underwent esophagectomy through cervico-thoraco-abdominal（3-field）approach between January 2007 and January 2009 in North Jiangsu Hospital were allocated into the tubular stomach group（group A, n=425） and the whole stomach group （group B, n=425）by operation order. Group A included 287 male and 138 female patients with their average age of 58.2±11.5 years. Among them, 27 patients had upper esophageal cancer, 346 patients had middle esophageal cancer and 52 patients had lower esophageal cancer. Group B included 298 male and 127 female patients with their average age of 58.5±12.8 years. Among them, 33 patients had upper esophageal cancer, 338 patients had middle esophageal cancer, and 54 patients had lower esophageal cancer. Operation time, postoperative length of hospital stay and the incidence of anastomotic leakage, anastomotic stricture, intra-thoracic stomach syndrome and reflux esophagitis of the two groups were compared. Results All the patients recovered uneventfully with no in-hospital death. There was no statistical difference in operation time （175.0±12.8 min vs.171.0±10.5 min，t=1.702，P＞ 0.05）and postoperative length of hospital stay （16.0±8.5 d vs.16.3±8.8 d，t=1.773，P＞ 0.05） between the two groups. During follow-up of six months, the rates of anastomotic leakage（χ2=5.550，P＜ 0.05）, intra-thoracic stomach syndrome （χ2=10.500，P＜ 0.05）and reflux esophagitis（χ2=9.150，P＜ 0.05） of group A were significantly lower than those of group B. There was no significant difference in the incidence of anastomotic stricture （χ2=0.120，P＞ 0.05） between the two groups. Conclusion Tubular stomach is better than whole stomach for cervical esophageal reconstruction after esophagectomy for esophageal cancer since it is more physiologically and anatomically complied. It can decrease the incidence of anastomotic leakage, intra-thoracic stomach syndrome, reflux esophagitis and improve the postoperative quality of life.
