| BackgroundEsophageal cancer is a highly malignant tumor that poses a significant threat to global public health,and a large number of patients are detected with the disease every year worldwide.According to statistics,in 2020 the total number of new cases of oesophageal cancer worldwide was 604,000 and the number of patients who died in the same period was 544,000,with a fatality rate of 90%.Esophageal cancer ranks sixth among all types of cancers in terms of incidence and mortality rates.In China,there were 324,400 new patients with oesophageal cancer,accounting for approximately 55.35% of global cases.Currently,the primary treatment for esophageal cancer is surgery,with chemotherapy and immunotherapy as adjuvant therapies.The stomach is commonly used as the first choice for reconstruction of the digestive tract.However,with the quick advancement of micro-invasive procedures,in-depth research on targeted/immunotherapy,and the development of personalized treatment plans for esophageal cancer,postoperative survival has been extended.Nevertheless,the increasing number of esophageal cancer patients experiencing recurrence after surgery has become a prominent issue.For patients with recurrent gastric cancer after esophageal cancer radical surgery and patients with esophagogastric junction cancer,traditional surgical methods are no longer suitable for reconstruction.Therefore,the use of the jejunum and colon as reconstruction organs is common.In the 2010 s,foreign thoracic surgeons successively performed the first colon-esophageal anastomosis surgery and the first small intestine-esophageal anastomosis surgery.After several decades of continuous innovation and development,transverse colon reconstruction has made significant progress and is widely used in many countries and regions.However,conventional open thoracic transverse colon reconstruction is limited by its complex surgical process and high intraoperative technical requirements,making it challenging to carry out and promote on a large scale.With the continuous development and updating of surgical concepts and advanced medical equipment,our institute has used thoracoscopic assistance,mechanical anastomosis and preoperative 3D reconstruction to improve the traditional procedure,but the advantages and disadvantages of the application of the traditional procedure and the new technology have not yet been clearly defined,making there no consistent surgical model for colonic substitution for oesophageal surgery.ObjectiveBy comparing and analyzing the data of various indicators between the modified transverse colon esophagoplasty and traditional transverse colon esophagoplasty,the advantages and disadvantages of the two procedures are compared,and the clinical efficacy of the modified transverse colon esophagoplasty is evaluated.It is revealed that the modified transverse colon esophagoplasty technique allows for standardized,precise,and minimally invasive operations,achieving the goal of standardized surgical procedures that are easy to promote.Materials and MethodsA retrospective analysis was conducted on the clinical data of 41 patients with esophageal cancer who were unable to use the stomach as a reconstructive organ and were treated at the Department of Thoracic Surgery of our Hospital from March 2017 to March 2022.Patients were screened according to predetermined inclusion and exclusion criteria and were divided into two groups based on the surgical method: the traditional group(19 cases)and the modified group(22 cases),in which the modified transverse colon esophageal replacement surgery was performed.The surgical time,intraoperative bleeding,lymph node dissection,postoperative drainage,and postoperative complications(anastomotic fistula,injury to the laryngeal recurrent plexus nerve,etc.)were analyzed and summarized for both groups.ResultsAll 41 cases were operated successfully without any deaths.The time of chest surgery(209.79±17.68 versus 186.81±10.07)min,intraoperative bleeding(287.37±44.61 versus 246.59±42.13)ml,drainage on the third postoperative day(818.95±152.06 versus 710.91±142.66)ml,the number of lymph node clearance(19.09±2.51 versus 21.42±2.34)and postoperative hospital stay(18.37±3.96 versus(15.64±3.44)d.The modified group was significantly better than the conventional group in terms of indicators.There was no statistically considerable comparison between the two groups in respect of the number of lymph node clearance,postoperative anastomotic fistula,anastomotic stricture,pulmonary complications,chylothorax,or recurrent laryngeal nerve injury.Forty cases were investigated after surgery,one case was missed,the follow-up time ranged from 12 to 36 months,with a mediocre time of 26 months,and one case of recurrence and metastasis,1-year viability 100%(40/40).Conclusion1.The modified transverse colonic substitution esophagus procedure is improved in three aspects:surgical planning through preoperative three-dimensional reconstruction,thoracoscopic assistance and mechanical anastomosis,which makes the surgical procedure standardized and proceduralized,and facilitates its widespread application in clinical practice.2.Modified transverse colon substitution for the oesophagus can effectively shorten the operation time,reduce the surgical trauma and speed up the postoperative recovery compared with the traditional operation.It can be used as an effective means of oesophageal reconstruction for patients with oesophageal cancer after major gastrectomy and patients with oesophagogastric double origin cancer. |
