Objective
To compare the outcome of tubular stomach and cervical esophagus laminated anastomosis and mechanical anastomosis.
Methods
A total of 128 patients with middle and upper esophageal cancer in our hospital from January 2013 to January 2016 were randomly divided into two groups, 64 patients in each group and all patients underwent esophagectomy. In the group A, there were 46 males and 18 females with age of 40–75 years, treated with tubular stomach and cervical esophagus layered anastomosis. There were 51 males and 13 females with age of 43–71 years in the group B receiving mechanical anastomosis. We observed the short-term and long-term efficacy as well as complications.
Results
In the group A, there was cervical anastomotic fistula in 1 patient, anastomotic stenosis in 2 patients and reflux esophagitis in 12 patients. In the group B, 1 patient suffered chylothorax, 8 patients cervical anastomotic fistula, 4 patients anastomotic stenosis and 14 patients reflux esophagitis.
Conclusion
Layered anastomosis can effectively reduce the incidence of anastomotic fistula and stenosis. Tubular stomach can effectively prevent and reduce the reflux esophagitis, and the high long-term quality of life will be achieved after the operation.
ObjectiveTo systematically review risk factors for esophagogastric anastomotic leakage (EGAL) after esophageal cancer surgery for adults to provide theoretical basis for clinical prevention and treatment.MethodsPubMed, Web of Science, The Cochrane Library, WanFang Data, VIP, CNKI and CBM were searched from inception to January 2020 to collect case control studies and cohort studies about risk factors for EGAL after esophageal cancer surgery. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 33 studies were included, including 19 case-control studies and 14 cohort studies, all of which had a Newcastle-Ottawa Scale (NOS)≥6. There were 26 636 patients, including 20 283 males and 6 353 females, and there were 9 587 patients in China and 17 049 patients abroad. The results of meta-analysis showed that the following factors could increase the risk for EGAL (P≤0.05), including patient factors (18): age, sex, body mass index (BMI), smoking history, smoking index (≥400), alcohol history, digestive tract ulcer, respiratory disease, lower ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), chronic obstructive pulmonary disease (COPD), coronary atherosclerosis, peripheral vascular disease, arrhythmia, diabetes, hypertension, cerebrovascular disease, celiac trunk calcification and descending aortic calcification; preoperative factors (6): abnormal liver function, renal insufficiency, American Society of Anesthesiologists (ASA) grading, neoadjuvant radiotherapy and preoperative albumin<35 g/L, preoperative lower albumin; intraoperative factors (7): retrosternal route, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, splenectomy; postoperative factors (5): respiratory failure, postoperative arrhythmia, use of fiberoptic bronchoscopy, pulmonary infection, deep venous thrombosis. Neoadjuvant chemotherapy could reduce the risk for postoperative EGAL (P<0.05). However, age≥60 years, upper gastrointestinal inflammation, diffusing capacity for carbon monoxide (DLCO%), thoracic surgery history, abdominal surgery history, glucocorticoid drugs history, neoadjuvant chemoradiotherapy, anastomotic embedding, end-to-end anastomosis, hand anastomosis, intraoperative blood loss and other factors were not significantly correlated with EGAL.ConclusionCurrent evidence suggests that the risk factors for postoperative EGAL include age, sex, BMI, smoking index, alcohol history, peptic ulcer, FEV1/FVC, COPD, diabetes, ASA grading, neoadjuvant radiotherapy, preoperative albumin<35 g/L, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, intraoperative splenectomy, postoperative respiratory failure, postoperative arrhythmia and other risk factors. Neoadjuvant chemotherapy may be the protection factor for EGAL. Due to limited study quality, more high quality studies are needed to verify the conclusion.
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.
The incidence and mortality of esophageal cancer are high, with strong invasiveness and poor prognosis. In China, the number of morbidity and death accounts for about half of the world. The cause of the disease has not yet been clarified, and it is known to be related to many factors such as chronic damage to the upper digestive tract caused by poor diet and lifestyle, heredity and environment. With the continuous advancement of molecular biology technology, metagenomics and high-throughput sequencing began to be used as non-culture methods instead of traditional culture methods for micro-ecological analysis, and is becoming a research hotspot. Many studies have shown that the disturbance of upper digestive tract microecology may be one of the causes of esophageal cancer, which affects the occurrence and development of esophageal cancer through complex interactions with the body and various mechanisms. This paper reviews the research progress, which is of great significance to further clarify the value of upper gastrointestinal microecology in the pathogenesis, diagnosis and treatment of esophageal cancer.
ObjectiveTo investigate the short-term follow-up results of inflatable mediastinoscopy combined with laparoscopy in the treatment of esophageal cancer.MethodsClinical data of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy were enrolled in our hospital from January 2017 to January 2019. Patients were divided into two groups according to different surgical methods, including a single-port inflatable mediastinoscopy combined with laparoscopy group (group A, n=59, 53 males and 6 females, aged 63.3±7.6 years, ranging from 45 to 75 years) and a video-assisted thoracoscopy combined with laparoscopy group (group B, n=43, 35 males and 8 females, aged 66.7±6.7 years, ranging from 50-82 years). The short-term follow-up results of the two groups were compared.ResultsCompared with the group A, the rate of postoperative pulmonary complication of the group B was significantly lower (18.64% vs. 4.65%, P<0.05). There was no significant difference between the two groups in other postoperative complications (P>0.05). The 6-month, 1-year, and 2-year survival rates were 96.61%, 89.83%, and 73.33%, respectively in the group A, and were 95.35%, 93.02%, and 79.17%, respectively in the group B. There was no significant difference in short-term survival rate after operation (P>0.05).ConclusionIn the treatment of esophageal cancer, the incidence of pulmonary complications of inflatable mediastinoscopy combined with laparoscopy is lower than that of traditional video-assisted thoracoscopy combined with laparoscopy, and there is no significant difference in other postoperative complications or short-term survival rate between the two methods. Inflatable mediastinoscopy combined with laparoscopy for radical esophageal cancer is a relatively safe surgical method with good short-term curative effects, and long-term curative effects need to be further tested.
[Abstract]Currently, there is no high-level evidence to support the benefit of postoperative adjuvant therapy for patients with resectable esophageal squamous carcinoma. By reviewing existing studies, this article analyzes the role of postoperative adjuvant therapy in resectable esophageal squamous carcinoma from four aspects, namely, the contradiction between the needs of clinical practice and the guidelines, the evolution of postoperative adjuvant therapy, the progress of the research on high-risk factors, and the outlook for the future, and elaborates on the high-risk factors that can be used as screening for postoperative adjuvant therapy. Thus, it provides reference for individualized and precise treatment of resectable esophageal squamous carcinoma.
ObjectiveTo investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer.MethodsThe clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including 89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group (IL group, 72 patients) and a McKeown group (MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography (EIT) parameters, postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared.ResultsThe operation time (262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time (10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay (14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group (P<0.05). The blood loss (156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection (29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant (P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 levels (Ftime point=520.543, 272.379, 147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8 (P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups (P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and atelectasis, anastomotic leakage, gastric wall necrosis and stump fistula, secondary thoracotomy and abdominal hemostasis, and intestinal obstruction were lower, but the differences were not statistically different (P>0.05). The recurrence rate of patients in the IL group within 6 months was lower than that in the MK group, but the difference was not statistically significant (8.33% vs. 9.09%, P>0.05).ConclusionJejunostomy combined with Ivor-Lewis or McKeown surgery have equivalent effects on patients with middle and lower esophageal cancer.
Objective To systematically review the prognostic significance of extranodal extension in gastric cancer, esophageal cancer and gastroesophageal junction cancer. Methods We searched EMbase, The Cochrane Library (Issue 9, 2016), PubMed, CBM, CNKI, VIP and WanFang Data databases from inception to August 2016, to collect cohort studies about the prognostic significance of extranodal extension. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. Results A total of 16 studies involving 9 445 participants were included. The results of meta-analysis showed that for gastric cancer patients, the overall survival (OS) (HR=1.71, 95%CI 1.49 to 2.00,P<0.000 01), disease free survival (DFS) (HR=1.39, 95%CI 1.12 to 1.73,P=0.003) and cancer specific survival (HR=1.52, 95%CI 1.18 to 1.96,P=0.001) in ENE(+) group were lower than ENE(–) group. For esophageal cancer and gastroesophageal junction cancer patients, the overall survival (OS) (HR=1.84, 95%CI 1.49 to 2.27,P<0.000 01), disease free survival (DFS) (HR=2.18, 95%CI 1.70 to 2.81,P<0.000 01) and cancer specific survival (HR=1.73, 95%CI 1.19 to 2.52,P=0.004) in ENE(+) group were lower than ENE(–) group. Conclusion Current evidence indicates that ENE(+) was correlated with a poor prognosis in gastric cancer, esophageal cancer and gastroesophageal junction cancer patients. Due to the quantity and quality limitations of included studies, more high quality cohort studies are needed to verify the above conclusions.
ObjectiveTo explore the possible factors which influence the survival time of elderly patients with esophageal cancer.MethodsWe retrospectively analyzed the data of patients with esophageal cancer treated in the First Hospital of Lanzhou University, Gansu Province Tumor Hospital from January 2012 to October 2016. Kaplan-Meier method was used to estimate and analyze the single factor, survival curve with log-rank test. The Cox regression model was used for multivariate prognostic analysis．ResultsAccording to the inclusion and exclusion criteria, 302 patients were eventually collected, including 231 males and 71 females, with an average age of 66.0±6.0 years. The univariate analysis showed that age, tumor stage, tumor site, Karnosfsky performance satus (KPS) score, and treatment were prognostic factors (P<0.05). Multivariate analysis showed that the patient age and treatment were independent factors for overall survival (OS) and progress-free survival (PFS) (P<0.05). The OS and PFS of the patients with age≤70 years were better than those of the patients more than 70 years. Chemotherapy alone and surgery alone was better for survival situation than radiotherapy alone.ConclusionAge and treatment are independent prognostic factors in survival time of the elderly patients with esophageal cancer.
In recent years, robot-assisted esophagectomy has become increasingly widespread, but the esophagogastric anastomosis step remains relatively complex and cumbersome. Currently, commonly used gastrointestinal reconstruction anastomosis techniques include end-to-end anastomosis, end-to-side anastomosis, and side-to-side anastomosis. Depending on the anastomosis method, they can be further divided into manual anastomosis and mechanical anastomosis, with common instruments including circular staplers and linear staplers. In esophageal cancer surgery, the choice of esophagogastric anastomosis technique is typically based on the tumor’s location and size as well as the surgeon’s preference. Each anastomosis technique has its advantages and disadvantages. With continuous improvements in anastomosis techniques and updates in stapling instruments, the incidence of complications after esophagogastric anastomosis has been effectively reduced. However, safely and efficiently completing gastrointestinal reconstruction during surgery remains a significant challenge. Scholars have made extensive explorations in this field, actively proposing and achieving various reconstruction methods, leading to significant progress. This article reviews the research progress of robot-assisted esophagogastric anastomosis techniques from both the anastomosis techniques and methods perspectives.
