Clinical Comparison Of Manual Stratified Anastomosis And Mechanical Anastomosis In Mckeown Operation For Esophageal Cancer

Research background and purpose:Esophageal cancer is one of the common and fatal digestive tract malignancies.With the development of surgical techniques for esophageal cancer,the incidence of postoperative complications has been significantly reduced,but the degree of their harm is still high and deserves attention from clinicians.Although pulmonary complications are the most common postoperative complications,anastomotic related complications such as anastomotic leak and anastomotic strictures are of the greatest concern,seriously affecting patients’ near-and long-term outcomes and quality of life.Among the surgical anastomoses for esophageal cancer,instrumented anastomoses have many advantages,such as convenience and easy operation,and are the most common anastomoses used in the clinic so far;But there are still quite a few clinicians who are more trusted to the handsewn anastomosis.There have been many clinical studies comparing postoperative complications between the two anastomotic modalities,but the results vary and do not prove which anastomosis is better.There is a large variety of handsewn anastomoses,among which the handsewn split thickness anastomosis is widely used because of its unique advantages,and as the technology evolves,the handsewn end-to-end split anastomosis is gradually applied in the clinic,although it currently appears that the application is quite good,but there are few research data.Besides that,endoscopic esophageal cancer surgery is characterized by high difficulty,refinement,and invasiveness,and it is demanding for the operating surgeon,so endoscopic esophageal cancer surgery generally has a long learning curve.Because of the characteristics of the disease species,patients with esophageal cancer have relatively general economic conditions and need to bear a higher pressure of medical expenses,so the decision to choose to reduce medical expenses is also very important in the premise of ensuring the safety of medical treatment.The aim of this study was to compare the differences between manual end-to-end stratified anastomosis and instrumented anastomosis in thoracoscopy combined with esophagectomy in terms of postoperative anastomotic leakage,anastomotic stricture,pulmonary complications,blood transfusion,critical illness,postoperative hospital days,operative time,intraoperative blood loss and related expenses,and to analyze the learning curve of the manual end-to-end stratified anastomosis group,which was grouped according to mastery and contrasted with the above indexes.To evaluate the safety,feasibility,and characteristics of the 2 anastomotic modes of hand to end split anastomosis.Materials and Methods:From January 2018 to December 2022,the patients who underwent thoracic and laparoscopic surgery combined with radical resection of esophageal cancer(Mc Keown MIE)in the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Chengdu Medical College were retrospectively analyzed.After inclusion and exclusion,they were divided into manual end-to-end layered anastomosis group(119 cases)and instrument anastomosis group(73 cases)according to the different types of anastomosis.The measurement data between the two groups were compared by t test or rank sum test,the counting data by chi-square test or Fisher’s exact test,and the grade data by rank sum test.Inspection level α= 0.05.Result:In the operation of thoracolaparoscopy combined with esophageal cancer,there is no significant difference in the postoperative complications such as anastomotic leakage,atelectasis,lung infection,pleural effusion and serious transfer to the department of critical medicine between manual end-to-end stratified anastomosis and instrument anastomosis,but the incidence of anastomotic stenosis is lower than that of instrument anastomosis;In patients with anastomotic fistula,the hospital stay after manual end-toend layered anastomosis is shorter.Manual end-to-end layered anastomosis requires longer operation time and anesthesia time than instrument anastomosis;Although the cost of manual end-to-end layered anastomosis is lower than that of instrument anastomosis in terms of consumables and cutting sutures,there is no significant difference in the total cost of hospitalization.The learning curve of manual end-to-end stratified anastomosis is expected to be 40 cases.After passing the learning curve,there will be lower incidence of anastomotic leakage,operation time and intraoperative bleeding,but there is no significant difference in atelectasis,lung infection,pleural effusion,serious illness transferred to the department of critical medicine,and postoperative hospitalization days.