Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy.

BACKGROUND: For esophageal carcinoma patients with early gastrectomy, individualized surgical plans-including selection of replacement conduit and operation route based on patient's new lesion and surgical history-can achieve the desired therapeutic effect and improve postoperative life quality. We investigated the outcomes at our institution. METHODS: The clinical data of 42 esophageal carcinoma patients with early gastrectomy were analyzed retrospectively. RESULTS: Esophagectomy was performed combining replacement with remnant stomach in 16 patients, jejunum in 17, and colon in 9. Esophagectomy combining replacement with gastric remnant got advantages of shorter operation time and less bleeding over that of replacement with jejunum or colon. Gastric remnant group scored higher on the QLQ-C30 questionnaire than jejunum or colon group with respect to overall quality of life, physical function, and social relationships. In QLQ-OES18 questionnaire, the scores of appetite recovery and reflux mitigation were more favorable in remnant stomach group than those in jejunum or colon group. Survival analysis showed no significant difference in survival rate among the patients undergoing replacement with gastric remnant, jejunum, or colon. CONCLUSIONS: For esophageal carcinoma patients with early gastrectomy, esophagus-gastric remnant anastomosis possesses advantages of shorter operation time, less surgical trauma, and greater life quality after surgery.

Study on the association of gastric conduit width and postoperative early delayed gastric emptying in middle-lower esophageal cancer patients undergoing Ivor-Lewis procedure / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the relationship between gastric conduit width and postoperative early delayed gastric emptying (DGE) in patients with middle-lower esophageal carcinoma who underwent Ivor-Lewis operation.</p><p><b>METHODS</b>Clinical data of 282 consecutive patients with middle-lower esophageal cancer who underwent the Ivor-Lewis operation by same surgical team in our department from January 2013 to June 2015 were retrospectively analyzed. Patients were divided into three groups according to the width of gastric conduit: width > 5.0 cm as broad group (n=93); width 3.0-5.0 cm as moderate group (n=70); width < 3.0 cm as narrow group (n=119). The gastric conduits of patients in narrow group were completely positioned the esophageal bed and fixed to the pericardium posterior wall. None of patients received pyloroplasty or pylorotomy. Perioperative data, operation-associated complications, and postoperative upper gastrointestinal radiographic results(1 week and 4 weeks after operation) were compared among groups.</p><p><b>RESULTS</b>The baseline data among these groups were comparable in terms of age, gender, tumor TNM staging, pathological types, serum albumin level, and the rate of receiving neoadjuvant therapy(all P>0.05). There were no significant differences in operative time, blood loss, and postoperative hospital stay among groups(all P>0.05). No patients died during perioperative peried. Anastomotic leakage occurred in 2 cases, one from broad group and another from narrow group. The incidences of arrhythmia and postoperative pulmonary complications, including infection, atelectasis, pneumothorax, and pleural effusion were similar among groups (all P>0.05). The average amount of gastric juice drainage in narrow group was (98±57) ml/day, which was markedly lower than that in broad group [(157±62) ml/day, P=0.000] and in moderate group [(123±68) ml/day, P=0.008]. One week after operation, the overall incidence of DGE was 10.6%(30/282), the incidence of DGE in broad, moderate, narrow groups was 17.2%(16/93), 14.3%(10/70), and 3.4%(4/119) respectively, and broad and moderate groups had higher incidence as compared to narrow group (P=0.001 and P=0.006).</p><p><b>CONCLUSION</b>During the Ivor-Lewis operation, application of a narrow gastric conduit (width < 3.0 cm), which completely position the esophageal bed with fixation to the pericardium posterior wall, can significantly reduce the incidence of postoperative early DGE.</p>

Feeding tube placement and postoperative nutritional support for esophageal carcinoma patients / 中国肿瘤临床

Objective:This study aims to investigate the method and clinical outcomes of feeding tube placement and periopera-tive nutritional support for esophageal carcinoma patients. Methods:A total of 513 esophageal carcinoma patients who have undergone radical resection and reconstruction by a single operating group between January 2012 and December 2013 participated this study. Feed-ing tubes were inserted via the nasal path of 497 cases and by jejunostomy in 16 cases. Early enteral nutrition (EN) was administered through the feeding tubes 24 h postoperatively with a stepwise increase, whereas supplementation of parenteral nutrition (PN) was ter-minated until total EN. Results:Feeding tubes were successfully inserted in all patients during operation. No death or nutritional and metabolic disorders were documented during the observation period. No differences in anastomotic fistula, pulmonary complication, and incision infection were identified between the nasointestinal and jejunostomy groups (P>0.05). A higher incidence of intestinal ob-struction was observed in the jejunostomy group than in the nasointestinal group (P<0.05). Conclusion:Effective placement of nasoin-testinal tube and early enteral feeding are safe and effective methods for patients who have undergone esophagectomy for esophageal carcinoma.