Clinical Study Of Three Methods For Cervical Esophagogastric Anastomosis

Background and PurposeThe current standard of treatment for esophageal cancer continues to be esophagectomy, with or without neoadjuvant or adjuvant chemotherapy and/or radiation therapy. Esophagectomy carries a high risk of morbidity and mortality. Anastomotic leak is a feared and frequent complication leading to increased hospital stay and delay in resumption of oral intake. Different anastomotic techniques have been described in order to minimize this risk. To evaluate the results of cervical esophagogastric anastomosis using the three anastomosis methods, We have chosen205patients who underwent tranthoracic esophagectomy with two-field lymph node dissection and reconstruction with a gastric tube, for thoracic esophageal cancer. A circular stapled cervical esophagogastric anastomosis have been performed in87cases, side-to-side anastomosis in26cases and manually sewn anastomosis in92cases.MethodsBetween January2008and January2012,312patients underwent surgery for esophageal cancer. Among these patients,205patients who underwent tranthoracic esophagectomy with two-field lymph node dissection and reconstruction with a gastric tube, for thoracic esophageal cancer.A circular stapled cervical esophagogastric anastomosis was performed in87cases(Squamous cell carinoma VS Adenocarcinoma:82VS5), side-to-side anastomosis in26cases(All were squamous cell carcinoma) and manually sewn anastomosis in92cases(Squamous cell carinoma VS Adenocarcinoma:89VS3). All patients were RO resection.In the circular stapler group,64patients use SDH21(Johnson, USA),23patients use SDH25(Johnson, USA).A gastric tube,4-6cm wide, was made along the greater curvature of the stomach using linear staples (TLC-75). Through the left cervical incision, pulled out the esophagus, a circular stapled cervical esophagogastric anastomosis, side-to-side anastomosis or manually sewn anastomosis were performed. A Rubber drainage strip was placed in the anastomoticregion.Regular postoperative follow-up, which was performed at3,6, and12months, included laboratory screening, chest radiography, and CT or endoscopic examination of the anastomosis. And record the extent and scope of reflux esophagitis by Savary-Miller (1978) proposed classification of reflux esophagitis.ResultsAll patients were extubated immediately after the operation. Anastomotic leakage was noted in3patients(3.4%) in the circular stapler group and13patients(14.1%) in manually sewn group (P=0.012<0.05/3,χ2=6.27).There was no significant difference between circular stapler group and side-to-side group, manually sewn group and side-to-side group about anastomosis leakage. After the operation,5patients (5.7%) in the circular group, no patients in the side-to-side group and24patients (26.1%) in the manually sewn group developed a benign esophageal stricture. There was significant difference between circular stapler group and manually sewn group (P＜0.01, χ2=13.62), side-to-side group and manually sewn group (P=0.004<0.05/3,χ2=8.51). The incidence of reflux esophagitis in the three groups is not the same or not all the same. ConclusionsIn the three kinds of cervical esophagogastric anastomosis, the circular stapler can significantly reduce the incidence of anastomotic leakage, circular stapler group and side-to-side group anastomotic stenosis and reflux esophagitis were lower than manually sewn group. Cervical esophagogastric stapled anastomosis complications were low and easy to apply and worth promoting.