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Objective:To investigate the application value of pancreatoduodenectomy (PD) with preservation of the gastric tube.Methods:The retrospective and descriptive study was conducted. The clinicopathological date of 3 male patients who underwent PD with preservation of the gastric tube for the treatment of periampullary tumor in Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School from May 2018 to November 2019 were collected. The 3 patients were aged from 66 to 77 years, with a median age of 76 years. All 3 patients with surgical history of radical resection of esophageal tumors and tubular gastric surgery underwent PD with preservation of the gastric tube. Observation indications: (1) preoperative three-dimensional (3D) reconstruction; (2) surgical and postoperative situations; (3) follow-up. Follow-up using outpatient exa-mination or telephone interview was conducted to detect survival of patients and tumor metastasis and recurrence up to April 2021. Measurement date with skewed distribution were expressed as M(range).Count date were expressed as absolute numbers. Results:(1) Preoperative 3D recons-truction: results of preoperative 3D reconstruction for the 3 patients showed none of patients with vascular variation. (2) Surgical and postoperative situations: 3 patients underwent PD with preserva-tion of the gastric tube successfully. The operation time and the volume of intraoperative blood loss were 402 minutes(range, 345?480 minutes) and 330 mL(range, 300?400 mL) for the 3 patients. Of 3 patients, 1 case had postoperative grade B pancreatic fistula and 1 case had chylous leakage, respectively, who were improved after conservative treatment. There was no perioperative death. The duration of postoperative hospital stay was 18 days(range, 15?20 days) for the 3 patients. Results of postoperative histopathological examination for the 3 patients showed that 1 case with pancreatic cancer as T2N0M0 stage, 1 case with ampulla carcinoma as T2N0M0 stage and 1 case with intraductal papillary mucinous neoplasms of the pancreas. (3) Follow-up: 3 patients were followed up for 12 to 18 months, with a median follow-up time of 16 months. Results of abdominal enhanced computed tomography examination at postoperative 14 month for the 3 patients showed that the right gastroepiploic artery and vein around the pancreas were unobstructed. Of 3 patients, 1 case with pancreatic cancer who did not receive chemotherapy died at postoperative 14 months due to tumor recurrence and metastasis. There was no recurrence and metastasis in the other two cases.Conclusion:PD with preservation of the gastric tube is safe and feasible, which can be used for patients with periampullary lesions who underwent radical resection of esophageal tumors and tubular gastric surgery in the past.
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@#Objective To systematically evaluate the efficacy of tubular stomach and whole stomach reconstruction in the treatment of esophageal cancer. Methods We searched PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM databases to collect the randomized controlled trial (RCT) studies on the efficacy comparison between tubular stomach and total gastric reconstruction of esophagus in esophagectomy from their date of inception to May 2019. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of Twenty-nine RCTs were included, and 3 012 patients were involved. The results of meta-analysis showed that the postoperative complications such as anastomotic fistula [RR=0.64, 95%CI (0.50, 0.83), P=0.000 6], anastomotic stenosis [RR=0.65, 95%CI (0.50, 0.86), P=0.002], thoracic gastric syndrome [RR=0.19, 95%CI (0.13, 0.27), P<0.001], reflux esophagitis [RR=0.23, 95%CI (0.19, 0.30), P<0.001], gastric emptying disorder [RR=0.39, 95%CI (0.27, 0.57), P<0.001] and pulmonary infection [RR=0.44, 95%CI (0.31, 0.62), P<0.001] were significantly reduced, and the postoperative quality of life score and satisfaction were higher at 6 months and 1 year in the tubular stomach group (P<0.05). In terms of intraoperative blood loss and postoperative hospital stay, they were better in the tubular stomach group than those in the whole stomach group (P<0.05). However, there was no statistically significant difference between the two groups in operation time, postoperative gastrointestinal decompression time, postoperative closed drainage time, postoperative 1-year, 2-year and 3-year survival rate, postoperative quality of life score at 3 weeks and 3 months, and postoperative life satisfaction at 3 weeks. Conclusion The tubular stomach is more advantageous than the whole stomach in the reconstruction of esophagus after esophagectomy.
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@#Esophageal cancer is one of the most common malignant tumors in China. The comprehensive treatment of esophageal cancer based on operation is important. In recent ten years, with the development of surgical techniques and medical instruments, tubular stomach has been widely used. Although the advantages of tubular stomach are becoming more and more obvious, there are still many details and problems for the function and application of tubular stomach worthy of further discussion and study. In this paper, the technical progress, advantages, functions and applications of tubular stomach are reviewed and discussed, and the future prospect is predicted.
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@#Objective To compare short-term quality of life and postoperative complications in esophageal squamous cell carcinoma patients with different routes reconstruction after McKeown esophagectomy. Methods The clinical data of 144 patients with esophageal squamous cell carcinoma who received McKeown esophagectomy in Shanghai Chest Hospital from January 2016 to October 2016 were retrospectively reviewed. Among them 93 patients accepted retrosternal approach (a RR group, 71 males and 22 females at an average age of 63.5±7.7 years) and 51 patients accepted posterior mediastinal approach (a PR group, 39 males and 12 females at an average age of 62.3±8.0 years). Short-term surgical outcomes were compared and a Quality of Life Questionnaire of Patients Underwent Esophagectomy 1.0 was performed at postoperative 1st and 3rd month. Results There was no difference in two groups in sex, age, Body Mass Index (BMI), and location and clinical stage of tumors (P>0.05). The neoadjuvant therapy was more performed in the RR group (16.1% vs. 5.9%, P=0.075). There were more robot-assisted esophagecctomy operations performed in the PR group (52.9% vs. 45.2%, P=0.020). No significant difference was noted in operation duration, intraoperative blood loss or length of ICU stay between the RR and PR groups (251.3±59.1 min vs. 253.1±27.7 min, P=0.862; 223.7±75.1 ml vs. 240.0±75.1 ml, P=0.276; 3.7±6.6 d vs. 2.3±2.1 d, P=0.139). The patients in the PR group had more lymph nodes dissected and shorter hospital stay (P<0.001). Rate of R1/2 resection was higher in the RR group (12.9% vs. 5.9%, P=0.187). No surgery-related mortality was observed in both groups. The anastomotic leak and the anastomotic stricture was higher in the RR group than that in the PR group (25.8% vs. 5.9%, P=0.003). No significant difference was found between the two groups in the quality of life at postoperative 1st and 3rd month. However, the quality of life at postoperative 3rd month significantly improved in both groups (P<0.001). Compared with the PR group, the dysphagia was more severe in the RR group at postoperative 1st month (3.3±1.5 vs. 2.6±1.1, P=0.007), while the reflux symptom was lighter at postoperative 3rd month (3.0±1.8 vs. 3.6±1.6, P=0.045). Conclusion The two different routes reconstruction after McKeown esophagectomy are both safe and feasible. The anterior mediastinal approach increases the risk of anastomotic leak, but with low incidence of reflux symptom.
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Objective To investigate the application value of tubular gastric interposition for esophageal reconstruction in esophageal and gastric cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 6 patients with esophageal and gastric cancer who were admitted to the General Hospital of Jinan Military Area of PLA between January 2013 and December 2016 were collected.Among 6 patients,2 and 4 were respectively confirmed as mid-thoracic and low esophageal cancers;tumors of 4 and 3 patients were respectively located in the gastric antrum and gastric body at lesser curvature side,including 1 with tumor in the gastric antrum and body.Esophageal cancer and gastric tumor were simultaneous resected,and proximal stomach replaced esophagus resected,with a blood-supply through right gastroepiploic vessels.There was an anastomosis between proximal tubular stomach and esoghagus.According to resection extent of resection extent,distal anastomosis included:(1) tubular stomach-duodenum Billroth Ⅰ anastomosis in case 1;(2) tubular stomach-jejunum Billroth Ⅱ anastomosis in case 2,3 and 4;(3) tubular stomach-jejunum Billroth Ⅱ anastomosis + jejunum-jejunum side-to-side anastomosis in case 5 and 6.Observation indicators:(1) intra-and post-operative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and quality of life up to May 2017.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).Results (1) Iutra-and post-operative recovery situations:6 patients underwent successful operation.The operation time,volume of intraoperative blood loss,gastrointestinal function recovery time,drainage-tube removal time and duration of hospital stay were respectively (206 ± 50) minutes,(106± 24) mL,(3.8± 2.1) days,(6.8 ± 5.0) days and (12.5 ± 4.2) days.Of 6 patients,1 with postoperative aspiration pneumonia and 1 with incomplete intestinal obstruction were cured by medical treatment.There was no anastomotic complication.(2) Postoperative pathological examination:number of lymph node dissectted of 6 patients was 13 ± 3.Case 2 had intra-abdominal lymph node metastasis.Pathological type:esophageal cancers were comfirmed as squamous cell carcinomas,gastric tumor were comfirmed as adenocarcinomas in 5 patients and stromal tumor were in 1 patient.(3) Follow-up and survival situations:6 patients were followed up for 5-28 months,with a median time of 14 months.During the follow-up,case 1 had severe symptom of reflux,and other 5 patients didn't have symptoms of reflux.Case 2 died of abdominal metastasis at 11 months postoperatively,and other 5 patients had survival.Conclusion Tubular gastric interposition replacing esophagus resected is safe and feasible in esophageal and gastric cancer,easy to operate and consistent with the physiological characteristics,meanwhile,it will provide opportunities and options of radical resection.
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Objective To compare the control effect on postoperative GER disease between tubular EC stomach esophagus anastomosis and the traditional full stomach esophagus anastomosis.Methods From September 2010 to October 2015 in Bozhou People's Hospital,85 patients diagnosed with esophageal cancer undergoing elective resection were randomly divided into a tubular stomach EC group (45 cases) and total gastrectomy group (40 cases),two patients underwent esophageal resection,wherein the tubular stomach set of rows of tubular esophagus stomach anastomosis,total gastrectomy group underwent conventional full stomach esophagus anastomosis.After the surgery until the patient to return to normal gastrointestinal function uses dynamic monitor its pH 24h esophageal pH monitoring chamber,the other respectively after 1 March using RDQ Scale GER-related symptoms in patients with score,at the same time Statistics after 1 March of the occurrence of GER.Results There were no deaths occurred,and no occurrence of postoperative anastomotic fistula and thoracic gastric emptying dysfunction,etc;the two groups were almost reached full monitoring 24 h,and between groups while monitoring the total time,Li position monitoring time,there was no significant supine monitoring time (P＞0.05);24 h reflux episodes long tubular gastric reflux group and significantly less than the number of total gastrectomy group,the longest duration of reflux and pH value ＜4.00 The cumulative time was significantly shorter in total gastrectomy group,DeMeester scores were significantly lower than the total gastrectomy group,between groups were statistically significant (P＜0.01);postoperative gastric tube 1,March RDQ score and incidence of GER significantly lower than the total gastrectomy group,between groups were statistically significant (P＜0.01 or P＜0.05).Conclusion Tubular stomach esophagus anastomosis compared with conventional full stomach esophagus anastomosis resection of esophageal cancer has a more ideal GER disease control effect,and can provide a reference for the choice of nastomosis ways for patients with esophageal cancer surgery.
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Objective To explore which method is more advantaged by comparing two kinds of tubular stomach in esophageal cancer operation and the occurrence of postoperative complications.Methods There were 47 esophageal cancer patients and they were randomly divided into two groups:A group including 24 patients and making mechanical clipping lesser curvature,B group including 23 patients and hand-sewn shrink lesser,and the major complications were analyzed and compared.Results All patients underwent radical tumor resection without the operative mortality.There was 1 patient of acute hemorrhagic of gastric resection margin in A group,and there was 1 patient of thoracic gastric leakage and 1 patient of anastomotic fistula in B group.In 12-month follow-up,there was 1 patient of anastomotic narrow in A group and 4 cases in B group (P ＞ 0.05).After 3,6 and 12 months,emptying dysfunction was not found by upper gastrointestinal imaging and CT,but the thoracic stomach expansion was found in two groups,and the degree of thoracic stomach expansion in B group was more serious than that in A group,the part of the thoracic stomach of 3 patients in B group protruding into the opposite chest.There was 1 patient with thoracic-gastro syndrome after eating in A group and 3 patients in B group (P ＞ 0.05).There were 3 patients with mild reflux esophagitis in A group and 10 patients with serious reflux esophagitis in B group (P＜0.05).Conclusion Comparing two operative methods,the mechanical clipping lesser curvature is more advantaged than hand-sewn shrink lesser.
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Objective To study the effect of small incision plus tubular stomach on serum vascular endothelial growth factor(VEGF) and quality of life in patients with esophageal cancer.Methods 78 patients with esophageal cancer were randomly divided into two groups,the control group (n =36 cases) and the observation group (n =42cases).The patients in the control group were treated through the conventional operation,while the patients in the observation group were treated through small incision plus tubular stomach.Serum VEGF and quality of life were detected.Results Qualities of life in both two groups were improved after operation and it in the observation group was higher than that in the control group (t =4.36,P ＜ 0.05).Serum VEGF in both two groups were decreased after operation (t =26.11,12.28,all P ＜ 0.01).It in the observation group was lower than that in the control group (t =14.94,P ＜ 0.05).Conclusion Small incision plus tubular stomach can significantly improve serum VEGF and quality of life in patients with esophageal cancer.
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Objective To study the influence of the operation through tubular stomach plus mechanical anastomosis on the life quality of patients with esophageal cancer.Methods Seventy patients with esophageal cancer were treated by operation,tubular stomach plus mechanical anastomosis were used.They were followed up for six months.The quality of life was evaluated.Results The average time for the operation was 120 min and the average amount of bleeding was 291.3ml.Compared with before surgery,there was significant difference in emotion,activity,sleep and diet ( P ＜ 0.05 ).Conclusion The operation through tubular stomach plus mechanical anastomosis could significantly improve the quality of life of patients with esophageal cancer.