Application Study Of Tubular Stomach In Esophageal Resection

Objective: China is a high incidence country of esophageal cancer. Surgery is the first choice for esophageal cancer treatment. However, after esophageal resection, destruction of the normal gastrointestinal physiological and anatomical structure and the transaction of the vagal nerve lead to postoperative gastroesophageal reflux and delayed gastric emptying which seriously affect their quality of life. After resection of the esophagus, stomach is widely used as a substitute of the esophagus. There are two types of the stomach which is used as an esophageal substitute: total and tubular stomachs. The reported results have not shown the advantages of tubular stomach over total stomach. This paper aims to show the advantages and disadvantages between total and tubular stomachs as an esophageal substitute and discuss potential application of the tubular stomach as esophageal substitute, by comparing the operative and postoperative data between the two groups of patients.Methods: This study recruited 30 patients who underwent esophagectomy for cancer in the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University between July 2013 and March 2014. There were 22 males and 8 females, aged from 46 to 76 years. The patients were randomly divided into a tubular stomach as esophageal substitute group(n=15, 11 males, 4 females, mean age 61.5 years) and a traditional total stomach as esophageal substitute group(n=15, 11 males, 4 females, mean age 61.6 years), In the two groups, esophagectomy was performed via left lateral thoracotomy. In the tubular stomach group, the tubular stomach was constructed into 3 cm in width by resection of the lesser curvature with leaner cutter, and then anastomosis was performed in the upper thorax. In total stomach group, the stomach was oversewn along the lesser curvature to minimize the size of the stomach into 3 cm in width after anastomosis was completed. The operation time, blood loss, volume of gastric juice after surgery, alimentary tract decompression time, pleural drainage volume, chest drainage time, complications after surgery, postoperative care and hospitalization time were compared between the two groups of patients, and radionuclide gastric emptying and lung function were measured one week before surgery and 1, 4, 7 and 10 month after surgery. Quality of life was also investigated 1, 4, 7 and 10 month after surgery.Results:1 The operations for the two groups of patients were all successfully performed, and there was no statistical difference in their operation time, blood loss, volume of gastric juice after surgery, alimentary tract decompression time, pleural drainage volume, chest drainage time, postoperative care time and hospitalization time.2 As for postoperative complications, two patients had mediastinal esophageal fistula in the tubular stomach group, which was cured after conservative treatment. One patient developed anastomotic stricture, which was improved after esophageal dilation. The traditional total stomach group showed no complication.3 There was no significant difference in the radionuclide gastric emptying between the two groups before surgery, and no significant difference compared with normal gastric emptying either. The tubular stomach group was better than the traditional total stomach group in gastric emptying 1, 4 and 7 month after surgery(P=0.00), but there was no significant difference between the two groups at 10 month(P=0.467).4 There was no significant difference in preoperative lung function between the two groups. One month after surgery, the tubular stomach group was superior to the traditional total stomach group(P=0.02) in lung function; but 4, 7 and 10 month after surgery the two groups showed no statistical difference.5 In the investigation for the patients’ quality of life(QOL), there was no significant difference between the two groups 1 and 4 month after surgery(P=0.708, P=0.547); but the tubular stomach group showed better QOL scores than the traditional total stomach group 7 and 10 month after surgery(P=0.007, P=0.006).Conclusion: Tubular stomach as an esophageal substitute leads to more postoperative complications. However, its gastric emptying and postoperative pulmonary function are better. Tubular stomach is most likely to results in better QOL.