Background: To evaluate the short-term efficacy of azygos arch-sparing McKeown minimally invasive esophagectomy (McKeown-MIE). Methods: We retrospectively analyzed the clinical data of 221 patients with thoracic esophageal squamous cell carcinoma who underwent McKeown-MIE at the Department of Thoracic Surgery of Gaozhou People'sHospital from August 1, 2017 to September 30, 2019. According to whether the azygos arch was preserved or not, the patients were assigned to one of two groups: the preservation group (40 cases) and the ligation group (181 cases). Within 3 months of the operation, the perioperative outcomes and the postoperative short-term efficacy of the two groups were compared.Results: After propensity score (PS) matching, 40 pairs of patients were matched successfully. Between the two groups, there were no statistical difference in intraoperative blood loss, the number of lymph nodes dissected, thoracic drainage duration, fasting time, postoperative hospital stay time, and major postoperative complications (P>0.05). Compared with the ligation group, patients in the preservation group had a shorter intensive care unit (ICU) stay time, a shorter operative time, a lower volume of postoperative thoracic drainage (both the first 3 days and overall) following surgery, a tubular stomach that had a smaller caliber, and a lower incidence of tubular gastric malpositioning (P<0.05). Conclusions: Preserving the azygos arch during a McKeown-MIE is safe and feasible. Doing so, not only effectively restricts the expansion of the gastric conduit, leading to a lower incidence of malpositioning, but also dramatically reduces postoperative thoracic drainage, and ICU stay time.
The agricultural supply chain has to balance the economic, environmental, and social dimensions of sustainability. This paper investigates the green agricultural supply chain, consisting of a manufacturer and a retailer, who are both altruistic towards consumers. Such consumer-oriented altruism is different from the widely adopted enterprise-oriented altruism, which only measures the altruistic behaviors among supply chain enterprises. In the approach of game theory, the optimal operational decision is obtained, and thereby the economic, environmental, and social dimensions of sustainability are described rationally and attained, respectively. The impacts of consumer-oriented altruism on the sustainability of the green agricultural supply chain are analyzed and compared in a systematic way. A case study is carried out before drawing conclusions and managerial implications. The findings can be concluded as follows. Firstly, consumer-oriented altruism changes the operational performance of the green agricultural supply chain by enhancing the green level of agricultural products, cutting down the pricing decisions and marginal profit of each supply chain enterprise. Secondly, consumer-oriented altruism simultaneously facilitates each dimension of sustainability to different extents, and economic sustainability is promoted the most prominently, whereas environmental sustainability is improved the least. Thirdly, the retailer’s consumer-oriented altruism always improves each dimension of sustainability more than the manufacturer’s altruism does, and the advantage in the economic dimension is the most significant, while that in the environmental dimension is the smallest.
Background The purpose of this study was to investigate the effect of our revamped MIE-McKeown operation on postoperative gastrointestinal function recovery. Methods This revamped MIE-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk and with the tubular stomach buried throughout esophageal bed and azygos arch, has been implemented from July 2020 to July 2021 by the same medical team of Gaozhou People's Hospital thoracic surgery for 13 times. Preoperative clinical data, main intraoperative indicators and postoperative complications were observed. Results All patients had esophageal malignant tumors at the level of middle and lower thoracic non-azygous venous arch, with preoperative clinical stage CT1-2N0M0 stage i-ii. V-vst test was performed on the 7th postoperative day, and 10 patients were found to have no loss of safety/efficacy. There were 2 cases with impaired efficacy and no impaired safety, 1 case with impaired safety. There were 1 cases of pulmonary infection, 1 cases of anastomotic fistula combined with pleural and gastric fistula, 2 cases of hoarseness, 2 cases of arrhythmia, 10 cases of swallowing function were grade i, 2 cases of swallowing function were grade iii, 1 case of swallowing function was grade iv in watian drinking water test one month after operation. Conclusions Merit of this revamped MIE-McKeown operation is well preserving the integrity of azygos arch of vagus nerve and bronchial artery, and it is technically safe and feasible. No postoperative mechanical obstruction of thoracostomach, huge thoracostomach and gastrointestinal dysfunction occurs.
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