Embedded Three-Layer Esophagogastric Anastomosis Reduces Morbidity and Improves Short-Term Outcomes After Esophagectomy for Cancer

Sun, Haibo; Li, Yin; Liu, Xianben; Zhang, Rui-Xiang; Wang, Zongfei; Zheng, Yan; Qin, Jianjun; Li, Haomiao; Chen, Xiankai; Zhao, Wei

doi:10.1016/j.athoracsur.2015.09.094

Cited by 35 publications

(23 citation statements)

References 22 publications

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“…These cases were defined as secondary pneumonia. With the development of perioperative management of esophagectomy, the incidence of pneumonia decreased, especially for secondary pneumonia 7 8 . Knowledge of which patients are at higher risk for primary pneumonia may contribute to selection of patients for surgical intervention, institution of risk reduction measures, and allocation of resources for postoperative care.…”

mentioning

confidence: 99%

Predictive Effects of Lung function test on Postoperative Pneumonia in Squamous Esophageal Cancer

Wei

Wang

Shen

et al. 2016

Sci Rep

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Pulmonary function tests had prospective implications for postoperative pneumonia, which occurred frequently after esophagectomy. Understanding factors that were associated with pulmonary infection may help in patient selection and postoperative management. We performed a retrospective review of 2 independent cohorts including 216 patients who underwent esophagectomy between November 2011 and May 2014, aiming at identifying predictors of primary pneumonia. Univariate analysis was used to identify potential covariates for the development of primary pneumonia. Adjustments for multiple comparisons were made using False Discovery Rate (FDR) (Holm-Bonferroni method). Multivariable logistic regression analysis was used to identify independent predictors and construct a regression model based on a training cohort (n = 166) and then the regression model was validated using an independent cohort (n = 50). It showed that low PEF (hazard ratio 0.97, P = 0.009) was independent risk factors for the development of primary pneumonia in multivariate analyses and had a predictive effect for primary pneumonia (AUC = 0.691 and 0.851 for training and validation data set, respectively). Therefore, PEF has clinical value in predicting postoperative pneumonia after esophagectomy and it may serve as an indicator of preoperative lung function training.

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mentioning

confidence: 99%

Predictive Effects of Lung function test on Postoperative Pneumonia in Squamous Esophageal Cancer

Wei

Wang

Shen

et al. 2016

Sci Rep

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“…The majority of included studies reported on open oesophagectomy. Three studies 55,66,67 compared different types of hand-sewn layers and were therefore excluded from meta-analysis. The remaining 37 studies comprised 8571 patients.…”

Section: Resultsmentioning

confidence: 99%

Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

et al. 2020

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Background: Current evidence on the benefits of different anastomotic techniques (hand-sewn (HS), circular stapled (CS), triangulating stapled (TS) or linear stapled/semimechanical (LSSM) techniques) after oesophagectomy is conflicting. The aim of this study was to evaluate the evidence for the techniques for oesophagogastric anastomosis and their impact on perioperative outcomes. Methods: This was a systematic review and network meta-analysis. PubMed, EMBASE and Cochrane Library databases were searched systematically for randomized and non-randomized studies reporting techniques for the oesophagogastric anastomosis. Network meta-analysis of postoperative anastomotic leaks and strictures was performed. Results: Of 4192 articles screened, 15 randomized and 22 non-randomized studies comprising 8618 patients were included. LSSM (odds ratio (OR) 0⋅50, 95 per cent c.i. 0⋅33 to 0⋅74; P = 0⋅001) and CS (OR 0⋅68, 0⋅48 to 0⋅95; P = 0⋅027) anastomoses were associated with lower anastomotic leak rates than HS anastomoses. LSSM anastomoses were associated with lower stricture rates than HS anastomoses (OR 0⋅32, 0⋅19 to 0⋅54; P < 0⋅001). Conclusion: LSSM anastomoses after oesophagectomy are superior with regard to anastomotic leak and stricture rates.

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“…Esophageal cancer can be treated by various surgical procedures, the most common of which is gastric transposition for esophageal replacement and esophagogastrostomy. At present, common esophagogastrostomy methods include hand‐sewn and mechanical anastomosis . Manual full‐thickness anastomosis is the traditional esophagogastrostomy approach.…”

Section: Discussionmentioning

confidence: 99%

“…At present, common esophagogastrostomy methods include hand-sewn and mechanical anastomosis. 10,11 Manual fullthickness anastomosis is the traditional esophagogastrostomy approach. However, because of its long operative duration, the incidence of anastomotic fistula is high and it is less commonly used nowadays.…”

Section: Discussionmentioning

confidence: 99%

Pre‐embedded cervical circular stapled anastomosis in esophagectomy

Wang

Liang

et al. 2020

Thoracic Cancer

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Background Mechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications. Methods In total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre‐embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Results The results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205–300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8–14 days with an average of 10.3 days. Conclusion Our data revealed that pre‐embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma. Key points This new technique can significantly reduce the risk of anastomotic leakage. This study adds further details enabling a smooth pre‐embedded procedure to be performed.

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Embedded Three-Layer Esophagogastric Anastomosis Reduces Morbidity and Improves Short-Term Outcomes After Esophagectomy for Cancer

Cited by 35 publications

References 22 publications

Predictive Effects of Lung function test on Postoperative Pneumonia in Squamous Esophageal Cancer

Predictive Effects of Lung function test on Postoperative Pneumonia in Squamous Esophageal Cancer

Anastomotic techniques for oesophagectomy for malignancy: systematic review and network meta-analysis

Pre‐embedded cervical circular stapled anastomosis in esophagectomy

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