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Objective:To investigate the effect of total gastric replacement of esophagus and tubular gastric replacement of esophagus on gastroesophageal reflux after esophageal cancer surgery, and the correlation between the anastomosis position and width of tubular stomach and gastroesophageal reflux.Methods:Eighty-eight patients with esophageal cancer admitted to Lu′an Hospital of Peking University Medical Group were retrospectively analyzed. According to the operation methods, they were divided into study group (tube stomach instead of esophagus anastomosis) and control group (whole stomach instead of esophagus anastomosis). The effects of two operation methods on gastroesophageal reflux were compared, and the effects of the position and width of tube stomach instead of esophagus anastomosis on the symptoms were analyzed.Results:Three months after operation, the frequency of acid reflux ≥ 5 minand 24 h acid reflux in the study group were less than those in the control group: (2.5 ± 1.7) times vs. (6.2 ± 2.1) times, (17.3 ± 8.8) times vs. (31.5 ± 7.9) times; the total time of pH < 4 and the longest acid reflux time in the study group were shorter than those in the control group: (85.3 ± 30.1) min vs. (118.2 ± 32.6) min, (22.4 ± 6.8) min vs. (31.8 ± 7.4) min; and the differences were statistically significant ( P<0.05). The reflux disease questionnaire score and the incidence of gastroesophageal reflux disease in the study group were lower than those in the control group: (8.9 ± 4.6) scores vs. (13.8 ± 4.1) scores, 6.7%(3/45) vs. 23.3%(10/43), and the differences were statistically significant ( P<0.05). In the 4 subgroup of the study group, the incidence of reflux symptoms, pH<4 cumulative time and the number of reflux symptoms were the lowest in the cervical anastomosis+width<3 cm subgroup, and the histological inflammatory reaction grade of esophageal mucosa under endoscopy was the lightest in the study group, and the differences were statistically significant ( P<0.05). Conclusions:Compared with total gastric anastomosis, tube stomach instead of esophagus anastomosis can reduce the incidence of gastroesophageal reflux more effectively, and neck anastomosis+tube stomach width <3 cm and anastomosis method are the best for gastroesophageal reflux.
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Objective To investigate the clinical efficacy of thoracoscopic and laparoscopic radical resection for adenocarcinoma of the esophagogastric junction (AEG) with side-to-side tubular gastroesophagostomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 4 patients with AEG who were admitted to the First Affiliated Hospital of Xiamen University between November 2017 and June 2018 were collected.All the patients underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy and received 6 cycles of postoperative adjuvant chemotherapy with SOX regimen.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy situations and survival of patients up to Semptember 2018.Results (1) Surgical and postoperative recovery situations:4 patients successfully underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy,without conversion to thoracotomy,open surgery or perioperative death.Operation time,volume of intraoperative blood loss,time for postoperative fluid diet intake and postoperative drainage-tube removal time of case 1,2,3,4 were respectively 420 minutes,400 minutes,320 minutes,300 minutes and 100 mL,100 mL,150 mL,100 mL and 9 days,8 days,8 days,8 days and 11 days,10 days,10 days,10 days.Case 1 with mild pneumonia and hiccup and case 2 with mild pneumonia were improved by symptomatic treatment,case 3 and 4 didn't have complication.All the patients had postoperative patent anastomosis.Duration of postoperative hospital stay of case 1,2,3,4 were respectively 12 days,11 days,11 days,11 days.(2) Postoperative pathological examination:all the 4 patients had negative surgical margin.Number of lymph node dissected,number of positive lymph node,tumor diameter,Siewert type,depth of tumor infiltration,tumor histopathologic stage of case 1,2,3,4 were respectively 32,31,17,23 and 0,4,2,6 and 3.5 cm,5.0 cm,5.0 cm,4.0 cm and type Ⅱ,Ⅰ,Ⅱ,Ⅰ and subserosa,entire wall of the esophagogastric junction,subserosa,entire wall of the esophagogastric junction and Ⅱ A staging,Ⅲ B staging,Ⅱ B staging,Ⅲ A staging.Degree of tumor differentiation and pathological type were moderately differentiated adenocarcinoma in the 4 patients.(3) Follow-up and survival situations:4 patients were followed up for 3-10 months,with a median time of 5 months.During the follow-up,4 patients underwent chemotherapy and achieved disease-free survival.Conclusion Thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy is safe and feasible.
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Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.
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Objective To explore the feasibility of gastroesophagostomy when patients with esophagus carcinoma com bined with stomach carcinoma.Methods In March 2011 to May 2016,our department completed with the method of genera tion of esophagus stomach in the treatment of esophageal cancer merger 18 cases of gastric cancer patients.Age 52-67,16 ca ses of esophageal lesions located in the middle section,2 cases located in the chest.4 cases were gastric lesions located in the proximal stomach,14 cases were located in the distal stomach Four kinds of surgical methods can be chosen from.Proximal or distal stomach could be used to replace esophagus and the blood supply came from left gastric artery or right gastroepiploic artery.Stomach tissue separation and reverse gastric tube were used if the length of stomach was insufficieut.Results When resection of esophageal and gastric carcinoma were accomplished simultaneously,residue stomach can be used as a replacement of esophagus if patients were rigidly selected.Conclusion Residue stomach was a good substitute after radical resection of esoph agus and gastric dual-source carcinoma.Patients chosen and surgery design were both important.