The Application Of Intrathoracic Esophagogastric Totally Mechanical Side-to-side Anastomosis In Minimally Invasive Esophageal Cancer Surgery

Objective:This essay is aimed to study the safety and feasibility of inthoracic esophagogastric full mechanically side to side anastomosis in the operation of minimally invasive esophageal cancer.Methods: From September 2015 to March 2018,52 patients with lower thoracic esophageal cancer and esophagogastric junction cancer(siewert type I and II)were treated by thoracoscopic and laparoscopic esophagogastric mechanical anastomosis via right upper thoracic abdomen in thoracic surgery of Affiliated Hospital of Qingdao University.There were 29 cases with mechanical side-to-side anastomosis group and 23 cases with tubular stapler anastomosis group.We retrospectively analyzed and compared the clinical data of the patients,including gender,age,BMI,FEV1,DLCO,smoking history,drinking history,history of hypertension,respiratory history,tumor length,tissue typing,tumor location,pathological stage,anastomosis,operation time,intraoperative blood loss,removed number of lymph nodes and groups,postoperative complications(including anastomotic leakage,anastomotic stricture,pulmonary infection,chylothorax,arrhythmia,hoarseness,and gastric emptying disorder),chest drainage on the first postoperative day,chest tube indwelling,and postoperative hospital stay.TNM staging was performed according to the 8th edition of the American Cancer Federation(AJCC).Results:1.A comparative study of basic clinical data between the total mechanical side-to-side anastomosis and the tubular stapler anastomosis There were 52 patients in this study,including 29 patients with total mechanical lateral anastomosis and 23 patients with tubular anastomotic anastomosis.The basic data of the two groups,such as gender,age,BMI,FEV1,DLCO,smoking history,drinking history,respiratory disease history,history of hypertension,tumor length,tissue classification,tumor location,and TNM staging were not statistically significant(P>0.05).2.A comparative study of the Operative and Post-operative Bata between the mechanical side-to-side anastomosis group and the tubular stapler anastomosis group All the patients underwent Esophagectomy with Thoracoscopy and Laparoscopy forEsophageal Carcinoma,and both esophagogastric mechanical lateral anastomosis and tubular stapler anastomosis were proved to be successful,without any records of transferring,opening chest or opening abdomen.The anastomosis time of the total mechanical lateral anastomosis group and the tubular anastomosis anastomosis group were 26.35±5.90 min and31.04±6.71 min,the operation time were 318.97±6.85 min and 367.57±75.22 min,the chest tube indwelling time were 11.10±2.80 days and 13.52±2.17 days,and the postoperative hospital stay were 14.41±2.65 days and 16.70±4.37 days,respectively,with the difference being statistically significant(P<0.05).There was no significant difference in the intraoperative blood loss,the removed number of lymph nodes and groups,and the chest drainage volume on the first postoperative day in the total mechanical side anastomosis group and the tubular anastomosis group(P>0.05).3.A comparative study of the complications after total mechanical side-to-side anastomosis and tubular stapler anastomosis group The incidence of anastomotic leakage were 0% and 17.39%,and the incidence of anastomotic stenosis were 0% and 21.74% in the total mechanical lateral anastomosis group and the tubular anastomosis anastomosis group,respectively,with the difference being statistically significant(P<0.05).There were no significant differences in pulmonary infection,chylothorax,arrhythmia,hoarseness,and gastric emptying disorder in the total mechanical lateral anastomosis group and the tubular anastomosis group(P>0.05).Results:1.The intrathoracic esophagogastric total mechanical side to side anastomosis is safe and feasible to apply in the operation of minimally invasive esophageal cancer operation for the treatment of lower esophageal and esophagogastric junction cancer.2.Compared with tubular stapler anastomosis,this method can effectively reduce anastomosis and operation time,and reduce the incidence of anastomotic leakage and anastomotic stenosis.