Clinical efficacy of radical proximal gastrectomy with esophagogastrostomy and double-tract anastomosis for upper gastric cancer / 中华消化外科杂志

Objective:To investigate the clinical efficacy of radical proximal gastrectomy with esophagogastrostomy and double-tract anastomosis for upper gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 172 patients who underwent radical proximal gastrectomy for upper gastric cancer in Tianjin Medical University Cancer Institute and Hospital from January 2018 to December 2020 were collected. There were 147 males and 25 females, aged from 25 to 81 years, with a median age of 62 years. All the 172 patients underwent digestive reconstruction. Of the 172 patients, 83 cases undergoing esophagogastrostomy were allocated into esophagogastrostomy group, 89 cases undergoing double-tract anastomosis were allocated into double-tract anastomosis group. Patients were performed radical proximal gastrectomy combined with D 1+ lymph node dissection by attending surgeons from department of gastric cancer. The operator decided to adopt esophagogastrostomy or double-tract anastomosis for digestive reconstruction. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination, telephone interview, and online APP was conducted at postoperative 1 month, once three months within postoperative 2 years, and once six months within postoperative 2-5 years. The questionnaires of reflux esophagitis, gastroscopy and upper gastrointestinal angio-graphy were conducted to evaluate gastroesophageal reflux and anastomotic stenosis up to February 1, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Surgical situations: cases with open, laparoscopic or Da Vinci robotic surgery (surgical method), the number of metastatic lymph node, duration of postoperative hospital stay were 74, 9, 0, 2(range, 0-15), (12±4)days for the esophagogastrostomy group, versus 65, 15, 9, 3(range, 0-28), (11±3)days for the double-tract anastomosis group, respectively, showing significant differences in the above indicators between the two groups ( χ2=10.887, Z=-1.058, t=3.284, P<0.05). (2) Follow-up: 172 patients were followed up for 2-38 months, with a median follow-up time of 13 months. Cases with gastroesophageal reflux and anastomotic stenosis were 58 and 10 for the esophagogastrostomy group, versus 14 and 1 for the double-tract anastomosis group, respectively, showing significant differences in the above indicators between the two groups ( χ2=51.743, 7.219, P<0.05). Conclusions:For upper gastric cancer patients undergoing proximal radical gastrectomy, double-tract anastomosis is more suitable for Siewert type Ⅱ adenocarcinoma of esophagogastric junction in large curvature or lower located tumor. Compared with esophago-gastrostomy, double-tract anastomosis has lower incidence of postoperative gastroesophageal reflux and anastomotic stenosis, without increasing complications.

Double H-flap technique, an anti-reflux adjunct to esophagogastrostomy after proximal gastrectomy for gastric leiomyoma: A case report

@#A significant challenge after performing resection of the esophagogastric region, is the reconstruction that follows. Esophagogastrostomy is a simple and direct method to restore gastrointestinal continuity using a single anastomosis but is associated with reflux esophagitis and anastomotic stenosis. This case report presents a 29-year-old man with a bleeding gastroesophageal junction leiomyoma who underwent a proximal gastrectomy and an esophagogastrostomy reconstruction with a double H-flap technique to reduce the incidence of gastric reflux. This illustrative description of the double H-flap technique created a valve mechanism that mimicked the function of the resected sphincter and cardia. This antireflux adjunct technique is reproducible and effective in preventing gastroesophageal reflux symptoms after an esophagogastrostomy.

A Man with Dysphagia after Cervical Esophagogastrostomy: A Case Report / 대한연하장애학회지

Dysphagia caused by a functional gastric outlet obstruction is rare and the natural course of a functional gastric outlet obstruction is unclear. This paper reports a patient with dysphagia and a functional gastric outlet obstruction after a cervical esophagogastrostomy. A 62-year-old man with a history of esophageal cancer and cervical esophagogastrostomy presented with dysphagia and discomfort during meals. A videofluoroscopic swallowing study (VFSS) with barium revealed a mild increase in the post-swallow remnants and delayed emptying of the gastric outlet, reflecting a functional gastric outlet obstruction at the diaphragm. One month later, VFSS revealed a worsened functional gastric outlet obstruction at the diaphragm. A delayed chest X-ray showed worsened delayed emptying of the gastric outlet. A cervical esophagogastrostomy for early esophageal cancer can cause functional gastric outlet obstruction, presenting as dysphagia and discomfort during meals. Physicians should be concerned about dysphagia and the functional changes in the esophagus in patients with a cervical esophagogastrostomy.

Application value of modified serf-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery / 中华消化外科杂志

Objective To explore the application value of modified self-traction Overlap method in intrathoracic esophagogastrostomy of Ivor Lewis surgery.Methods The retrospective and descriptive study was conducted.The clinical data of 12 patients with lower esophageal carcinoma who underwent Ivor Lewis surgery in the Zhongshan Hospital of Fudan University from January to May 2018 were collected.There were 9 males and 3 females,aged from 50 to 73 years,with a median age of 61 years.Modified self-traction Overlap method was used for intrathoracic esophagogastrostomy during the surgery.The esophagus was pulled down with the ligature as traction and rotated clockwise by 45 degrees to perform side-to-side esophagogastric anastomosis.The common opening was closed by a laparoscopic linear cutting suturing device to form an esophagogastric Overlap triangle anastomosis,and finally the esophagus was disconnected.Observation indicators:(1) intraoperative and postoperative situations;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect survival situation and tumor recurrence and metastasis up to January 2019.Measurement data were described as M (range).Results (1) Intraoperative and postoperative situations:all the 12 patients underwent successful Ivor Lewis surgery,without conversion to open surgery.The operation time,time of tubular gastroesophageal anastomosis,volume of intraoperative blood loss,time to initial anal exsufflation and time for initial fluid diet intake were 145 minutes (range,125-189 minutes),20 minutes (range,16-35 minutes),98 mL (range,78-135 mL),4 days (range,3-5 days),6 days (range,5-7 days),respectively.All the patients had no complication.Patients underwent upper gastrointestinal iodine hydrography at 5 days after surgery,confirming no anastomotic leakage or stenosis.Patients recovered well and were discharged postoperatively.The duration of postoperative hospital stay was 8 days (range,7-11 days).(2) Follow-up situations:12 patients were followed up for 8.0-12.0 months,with a median time of 10.6 months.Patients survived well,with no tumor recurrence or metastasis.Condusion Modified self-traction Overlap method in thoracic esophagogastrostomy of Ivor Lewis surgery is safe and feasible for lower esophageal carcinoma,with easy operating

Clinical application of mediastinal elastic drainage-tube for patients with anastomotic leak after esophagus carcinoma or esophagogastric junction carcinoma surgery / 中国综合临床

Objective To study the clinical application of mediastinal elastic drainage-tube for patients with anastomotic leak after esophagus carcinoma or esophagogastric junction carcinoma surgery.Methods Two hundred and eighty-two cases esophagus carcinoma or esophagogastric junction carcinoma patients were randomly divided into 2 groups.The control group(n=140) were indwelled thoracic drainage tube after operation.However,the experimental group(n=142) were indwelled thoracic drainage tube and mediastinal elastic drainage-tube after operation.The incidence of the esophagogastrostomy fistula,diagnosis time of anastomotic leakage,maximum temperature,time of continuous ferer,total white blood cell count,cardiopulmonary complications,postoperative hospital stay,hospitalization expenses were observed and analyzed.Results (1)The incidence of the esophagogastrostomy fistula in the experimental group and the control group was 9.8%(14/142) and 12.1%(17/140),and there was no significant difference between the two groups(χ2=0.376,P>0.05).The diagnosis time of anastomotic leakage,maximum temperature,time of continuous ferer and total white blood cell count of the experimental group and the control group was (6.4±0.6) d and (10.6±0.6) d,(38.1±0.1)℃ and (39.0±0.2)℃,(72.2±2.8) h and (102.6±3.3) h,(12.6±0.7)×109/L and (19.7±0.6)×109/L after operation,there was significant difference between the two groups(t=2.708,1.662,3.164,1.837,P<0.05).The incidence of pulmonary complication,cordis complication of the experimental group and the control group was 19.7%(28/142) and 32.1%(45/140),18.3%(26/142) and 40.7%(57/140) after operation,there was significant difference between the two groups (χ2=5.077,6.606,P<0.05).The postoperative hospital stay,hospitalization expenses of the experimental group and the control group was (28.1±4.2) d and (45.6±3.9) d,￥(6 8174.7±3206.5) and￥(8 4774.8±4007.3) after operation,there was significant difference between the two groups(t=2.001,1.709,P<0.05).Conclusion The mediastinal elastic drainage-tube for patients with anastomotic leak after esophagus carcinoma or esophagogastric junction carcinoma surgery can not reduce the incidence of the esophagogastrostomy fistula,but which is conducive to the early diagnosis and timely treatment of anastomotic leakage.Meanwhile it can reduce the incidence rate of cardiac and pulmonary complications,shorten the length of stay in hospital,reduce the total cost of hospitalization.

The investigation of methods for prevention of anastomotic stenosis after resection of esophageal cancer / 中国癌症杂志

Background and purpose:Esophageal cancer is one of the common malignant tumors in our country. Anastomotic stenosis is a common complication after resection of esophageal cancer, seriously affecting the quality of life of patients after operation. By changing anastomosis, this study explored the methods for prevention of anastomotic stenosis after esophageal cancer surgery.Methods:Patients were randomly divided into groups. Patients admitted on odd dates were placed in the control group whereas patients admitted on even dates were placed in the experimental group. Patients in the control group were treated with gastroesophageal anastomosis using anastomat for gastroesophageal anastomosis. Anastomotic stomach was contracted by purse string suture at first, and then treated with stapler gastroesophageal anastomosis, before the gastroesophageal anastomosis was carried out on patients in the experimental group. After 6 months’ follow-up, the incidences of anastomotic stenosis between the two groups were compared.Results:The postoperative anastomotic stenosis rate in the control group was 19.2%, while that in the exper-imental group was 0%. There were statistically signiifcant differences between them (χ2=22.8,P<0.005). The incidence of anastomotic stenosis in the control group was signiifcantly higher than that in the experimental group.Conclusion:Anastomotic stomach contracted by purse string suture before stapler gastroesophageal anastomosis can effectively reduce the occurrence of anastomotic stenosis after esophageal cancer surgery.

Ivor-Lewis stapled cervical esophagogastrostomy via thorax for middle esophageal carcinoma: a prospective cohort study / 中华消化外科杂志

Objective To investigate the efficacy of the Ivor-Lewis cervical stapled esophagogastrostomy via thorax in the treatment of middle esophageal carcinoma.Methods The clinical data of 303 patients with middle esophageal carcinoma who were admitted to the Rugao Boai Hospital (107 patients) and the Rugao People's Hospital (196 patients) from March 2005 to March 2013 were prospectively analyzed.All the patients received Ivor-Lewis stapled cervical esophagogastrectomy (Ivor-Lewis group,151 patients) or Sweet stapled cervical esophagogastrostomy (Sweet group,152 patients) according to the admission order.The intraoperative condition,perioperative complications,lymph node dissection and postoperative follow-up of the 2 groups were analyzed.All the patients were followed up via out-patient examination till December 2012.The measurement data,enumeration data and the ranked data were analyzed using the independent samples t-test,chi-square test or Fisher exact probability and Wilcoxon rank sum test,respectively.The survival curve was drawn by the Kaplan-Meier method,and the postoperative mortality rate was analyzed using the Cox proportional hazard model.Results The operation time of the Ivor-Lewis group was (239 ± 21)minutes,which was significantly longer than (188 ± 30)minutes of the Sweet group (t =11.32,P ＜ 0.05).The surgical resection rate of the Ivor-Lewis group was 98.68％ (149/151),which was significantly higher than 92.76％ (141/152) of the Sweet group (x2 =6.45,P ＜ 0.05).The positive rate of the upper resection margin of the esophagus,postoperative morbidity rate and operative were 0.67％(1/149),10.07％ (15/149) and 0 in the Ivor-Lewis group,and 0.71％ (1/141),11.35％ (16/141) and 0.71％(1/141) in the Sweet group,with no significant difference between the 2 groups (P ＞ 0.05).The number of lymph nodes dissected from the cervical-thoracic junction and the upper abdomen were 3.6 ± 1.1 and 3.5 ± 1.1 in the Ivor-Lewis group,which were significantly greater than 2.3 ± 0.8 and 2.4 ± 0.8 in the Sweet group (Z =9.96,9.02,P ＜ 0.05).The number of positive lymph nodes dissected from the cervical-thoracic junction was 0.7 ± 1.1 in the Ivor-Lewis group,which was greater than 0.3 ± 0.6 of the Sweet group,with significant difference between the 2 groups (Z =3.26,P ＜ 0.05).Of the 290 patients who received surgical treatment,273 were followed up with the follow-up rate of 94.14％ (273/290),and the median time for follow-up was 28.0 months.The 1-,2-,3-year tumor recurrence rates were 8.21％ (11/134),19.64％ (22/112) and 29.35％ (27/92) of the Ivor-Lewis group,which was significantly lower than 19.05％ (24/126),35.24％ (37/105) and 44.19％(38/86) of the Sweet group (x2=6.55,7.33,5.03,P ＜ 0.05).There were significant differences in the 1-,2-,3-year locoregional recurrence rate of the lymph nodes between the 2 groups (x2 =7.03,9.68,6.87,P ＜0.05).The 1-,2-,3-year accumulative survival rates of the Ivor-Lewis group were 90.30％ (121/134),80.36％(90/112) and 71.74％ (66/92),which were significantly higher than 80.95％ (102/126),59.05％ (62/105)and 51.16％ (44/86) of the Sweet group (x2=4.65,1 1.73,7.97,P ＜ 0.05).Conclusion Ivor-Lewis stapled cervical esophagogastrostomy via thorax has advantages of high resection rate,better safety and better quality of life of patients,and it could be an optimized design of the treatment for patients with middle esophageal cancer without intumescent lymph node of neck.

Insertion of anvil into esophagus for anastomosis during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer / 中华消化外科杂志

Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction.

New technique of esophagogastrostomy and esophagojejunostomy after laparoscopic gastrectomy / 中华消化外科杂志

Objective To investigate the efficacy of transorally inserted anvil system(OrVilTM)in esophagogastrostomy and esophagojejunostomy after laparoscopic gastrectomy.Methods The clinical data of 34 patients with gastric neoplasms who were installed OrVilTM for esophagogastrostomy or esophagojejunostomy at the Changhai Hospital from July 2009 to February 2011 were retrospectively analyzed.After radical dissection of lymph nodes and full mobilization of esophagus,the esophagus was transected and the anvil was then transorally inserted into the esophagus by using the OrVilTB system.Double-stapling esophagogastrustomy or esophagojejunostomy with a circular stapler Was performed intracorporeally under direct laparuscopic view.Results The surgery was success fully completed in all the 34 patients with no conversion to open surgery.Two patients had difficulty in placing OrVilTM system.and the condition Was alleviated by reducing tension in the cuff and tilting the head back.The mean operation time,volume of blood loss,duration of postoperative hospital stay and time to gastrointestinal function recovery were 175 minutes(range,90-240 minutes),196 ml(range,50-800 ml),7.6 days(range,5-14 days)and 3 days(range,2-6 days).No postoperative anastomotic leakage Was detected.Thirty-three patients were followed up for 2-20 months with a mean time of(10±6)months,and no tumor recurrence or metastasis occurred.Conclusion OrVilTM system changes insert direction of the anvil,which significantly reduces the difficulty of laparoscopic operation,shortens the operation time and avoids the thoracotomy.

Gastropericardial Fistula as a Complication in a Refractory Gastric Ulcer after Esophagogastrostomy with Gastric Pull-Up

A gastropericardial fistula, defined as penetration of a gastric lesion into the pericardium, is a rare occurrence. Such a fistula is usually associated with a huge ulcer in the gastric fundus, an ulcer within a hiatus hernia, a history of esophagogastric surgery, the concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs), or Zollinger-Ellison syndrome. The patient in this case presented with shoulder pain and melena, caused by a gastropericardial fistula that had occurred as a late complication of postoperative esophagogastrostomy and a refractory gastric ulcer. Despite the severity of the condition, the patient showed great improvement after medical treatment and the fistula was cured at the end.

Surgical Treatment of Esophageal Adenocarcinoma in Barrett's Esophagus: A case report / 대한흉부외과학회지

Barrett's esophagus is precancerous lesion of esophageal adenocarcinoma, but this has been rarely reported in Korea. A 81-year-old man with esophageal adenocarcinoma was admitted to our hospital, and we performed a distal esophagectomy and end-to-end esophagogastrostomy. The microscopic examination of the resected tissue revealed the intestinal metaplasia with goblet cells around the esophageal adenocarcinoma, which indicates this was a Barrett's esophagus. We report here on this case along with a review of the relevant literature.

A Case of Gastrobronchial Fistula after Esophagectomy / 대한흉부외과학회지

Benign gastrobronchial fistula (GBF) after Ivor Lewis operation is a very rare and serious complication. We describe a patient with GBF who was successfully managed on the single-stage repair, 15 months after the Ivor Lewis operation. After the division of the GBF, the bronchial and gastric defects were closed directly. The omental flap and the pedicled 5th. intercostal muscle flap were interposed between the closed defects. The literature of this subject is reviewed and discussed.

Gastropericardial Fistula as a Late Complication after Esophagectomy with Esophagogastrostomy: A case report / 대한흉부외과학회지

A 56 year-old man complaining of dry cough, dyspnea, chest pain, fever, and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy and subsequent radiotherapy because of an esophageal cancer. After the emergency echocardiography revealed a small amount of pericardial effusion and pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach and the pericardium, and an emergency operation was done under the diagnosis of gastropericardial fistula. The patient expired postoperative seven days later. Gastropericardial fistula caused by a peptic ulcer perforation after the esophagectomy and esophagogastrostomy operation is a very rare complication and brings forth a disastrous result. Early detection using the chest radiography, electrocardiogram, upper GI study, echocardiography and a review of physical examination, and an immediate treatment are therefore mandatory.

Clinical Study of the Pylorus Preserving Proximal Subtotal Gastrectomy

PURPOSE: Many clinics have abandoned the use of a proximal subtotal gastrectomy for adenocarcinomas of the stomach because of the poor survival rate, the high incidence of operative complication, and the lack of an advantage saving the antral stump. The authors performed an esophagogastrostomy after a proximal subtotal gastrectomy without pyloroplasty and evaluated the outcome of this pylorus-preserving proximal subtotal gastrectomy. METHODS: After the pylorus-preserving proximal subtotal gastrectomy in 16 patients with a gastric adenocarcinoma, the status of the esophageal and gastric mucosa was evaluated using endoscopy, and the function of the pylorus was estimated using an upper gastrointestinal series. In this clinical study, the data were collected between September 1996 and August 1999 at Chungnam National University Hospital. RESULTS: The function of the pylorus of the stomach was well preserved without any severe reflux from the duodenum. The incidences of esophagitis and gastritis were 11 out of 16 patients and 3 out of 16 patients, respectively, in this operation. Esophageal stricture developed in 5 out of 16 patients. CONCLUSION: The pylorus-preserving proximal subtotal gastrectomy (without conventional pyloroplasty) is effective in terms of preventing postoperative reflux gastritis. The emptying mechanism of the pyloric sphincter and the reservoir function of the stomach were well preserved in this study. We think that the pylorus-preserving proximal subtotal gastrectomy is one of useful methods for early adenocarcinomas of the proximal stomach. However, reflux esophagitis and stricture of the esophagogastrostomy site are common problems to be solved in the future.

Esophagogastrostomy encircled by seromuscular gastric wall flap / 临床外科杂志

Objective To evaluate the effects of esophagogastroplasty of esophagogastrostomy in preventing anastomotic leakage,stricture and reflux esophagitis after resection of lower esophageal or cardiac carcinoma.Methods 273 cases of lower esophageal cardiac carcinoma were randomly divided into 2 groups:The treatment group(145 cases) was treated by esophagogastrostomy encircled by sero muscular gastric wall flap while the control group(128 cases) was performed with esophagogastrostomy only.Results No anastomotic leakage or stricture was observed in treatment group,with 10 cases of reflux esophgitis only.In control group,anastomotic leakage,stricture and reflux esophagitis were 9(7 0%),5(3 9%),and 21(17 1%) respectively.Conclusions The esophagogastroplasty of esophagogastrostomy can completely avoid anastomotic leakage,stricture and significantly reduce reflux esophagitis after resection of lower esophageal or cardiac carcinoma.

Esophagogastirc Anastomosis: Analysis of Postoperative Morbidity and Mortality / 대한흉부외과학회지

BACKGROUND: After an esophageal resection for an esophageal disease, the stomach becomes the most common organ for a substitute. The stomach has the advantages of being simple with fewer complications when used properly. The complications of an esophageal reconstruction using the stomach as the substitute are assessed and discussed. MATERIAL AND METHOD: Between 1990 and 1998, 44 patients who underwent esophagogastric anastomosis were treated in the department of Thoracic and Cardiovascular Surgery of Yongdong Severance Hospital, Seoul, Korea. RESULT: The rate of postoperative complications and mortality in these 44 patients were 70.5% and 13.6%, respectively. The major complications in our series involved the stricture of anastomosis(13.6%), pneumonia(11.4%), and wound infection(9.1%). The most frequent causes of postoperative deaths were pulmonary complications and sepsis(6.8%). CONCLUSION: Anastomotic leakage is no longer a major complication of an esophagogastrostomy. Most postoperative stricture can be overcome with frequent esophageal dilations. Postoperative pulmonary infection, nutrition, and physiotherapy are very important in reducing the rate of pulmonary morbidity and mortality.

Comparison and analysis of the operation approach of esophageal carcinoma / 中国癌症杂志

Purpose:To select a better operation approach for esophageal carcinoma. Methods:From 1958 to 1997, 945 patients of the middle third esophageal carcinoma of our hospital were underwent 5 types of operation.namely: left thoracic approach esophagectomy and esophagogastrostomy; right thoractomy anterolateral and abdomen esophagectomy and esophagogastrostomy; right thoractomy anterolateral and abdomen and cervical approach esophagectomy and esophagogastrostomy; right thoractomy posteriolateral, abdomen and cervical approach esophagectomy and esophagogastrostomy; simple right thoracic approach esophagectomy and esophagogastrostomy. The rate of resectability, rate of complication, rate of mortality and rate of survival of the 5 types of operation were using SAS package and significance test of contingency table. Results:The rate of resectability and the rate of 5 year survival in the five groups were 84.19% and 29.00%, 81.69% and 28.57%,83.65% and 26.19%,90.74% and 34.70%, 93.67% and 39.74%, respectively. Conclusions:Right thoracic approach esophagectomy and esophagogastrostomy are considered superior the operation approach of esophageal carcinoma.

Giant Cavernous Hemangioma of the Esophagus: One Case Report / 대한흉부외과학회지

Esophageal hemangioma is an extremely rare benign tumor that causes dysphagia and massive upper gastrointestinal bleeding. Although certain abnormalities seen on a barium swallow esophagography or at endoscopy may suggest an esophageal hemangioma, a contrast CT and radionuclide angiography using a blood-pool radiopharmaceutical can characterize the intense vascularity of the tumor. We experienced the ase of a 7x7x3.5 cm in size giant cavernous hemangioma of the lower 1/3 of esophagus in a 40 year old man. A mural cavernous hemangioma was diagnosed with a barium swallowed esophagogaphy, endoscopy, and a contrast CT. It was treated successfully by transthoracic esophagectomy including the tumor and esophagogastrostomy.

A Study of Anastomotic Stricture after EEA Stapled / 대한흉부외과학회지

BACKGROUND: The advent of EEA stapler has lowered the leakage rate of esophagogastric anastomoses and thereby contributed to a decrease in the operative mortality of the easophageal resection. Recent surgical reports, however, have documented 10% to 20% prevalence of benign anastomotic stricture formation after the use of EEA stapler to construct an esophagogastric anastomosis. We analyzed the cases of anastomotic strictures to reduce the incidence of anastomotic strictures with EEA stapled esophagogastrostomy. MATERIAL AND METHOD: EEA stapled esophagogastrostomy was performed in 195 parients during the period of over 11 years from Jan. 1986 to Dec. 1996 in Kosin Medical Center. Ten patients of them died in the early postoperative days. In the remaining 185 patients, we studied the incidence and the onset time of anastomotic strictures, relationship between the patients' ages, the anastomotic sites, and the size of the cartridges with incidence of anastomotic stricture. We also studied the method of treatment and its effect in the anastomotic strictures. RESULT: Benign anastomotic strictures occurred in 39 cases among 185 patients (21%), 25 cases (64.1%) of the 39 cases developed in one to three months postoperatively. The patients' ages and the anastomotic sites did not effect with the incidence of anastomotic stricture, but high incidence of anastomotic stricture in EEA stapled esophagogastrostomy (p=0.04)was observed in small cartridge sizes. One or two balloon dilatation (89%) relieved the anastomotic strictures. CONCLUSION: We conclude that a larger size cartridge is recommended in EEA stapled esophagogastrostomy to reduce the incidence of anastomotic stricture if possible, and one or two balloon dilatation would seem to be a safe and reliable method in treating anastomotic stricture when the anastomotic stricture was occurrs.

Perioperative Changes of Serum Total CK and CK-MB in Patients with Carcinoma of Esophagus and Cardia of the Stomach / 中华胸心血管外科杂志

The perioperative total serum CK and CK-MB activities were determined in 38 patients with carcinoma of the esophagus and cardia of the stomach with fluorometric and cylinder layer chromatography. The data were compared with those obtained from 18 patients undergoing pulmonary operation and 20 normal subjects. The results suggest that: (1) carcinoma of the esophagus and cardia of the stomach could not induce variation of the total serum CK and CK-MB; (2) the elevation of the total serum CK after esophagogas-trostomy might probably be due to the trauma of the skeletal muscles of the chest wall;(3)the total serum CK is non-specific for the diagnosis of AMI in the perioperation period,but CK-MB might be considered as a specific enzyme criteria.