Fixed in the neck or pushed back into the thorax?—Impact of cervical anastomosis position on anastomosis healing

Abstract

Contributions: (I) Conception and design: YD Lin; (II) Administrative support: YD Lin; (III) Provision of study materials or patients: YD Lin;

RETRACTED: A study on expression level and nutritional status of IGFBP-2 after left neck anastomosis combined with placement of feeding nutritional applicators carrying ^(125)I particles in the treatment of esophageal cancer

“…Generally, surgical resection is a preferred treatment option for tumor patients. For esophageal cancer patients, left neck anastomosis is usually combined with tumor resection to rebuild the digestive tract and provide conditions for postoperative nutritional support ( 3 ). At present, placement of feeding nutritional applicators carrying ^(125)I particles is a relatively novel treatment method.…”

Thoracolaparoscopic esophagectomy for esophageal cancer with a cervical or abdominal incision to extract specimen

“…After investigating factors affecting gastro-esophageal cervical anastomotic leakage, Luo et al found that cervical anastomosis fixation, hypertension, and anastomosis mode are independent risk factors. [ 3 ] In their study, cervical gastro-esophageal anastomosis was performed either with hand sewing or with a circular stapler, and the anastomosis was either fixed in the neck by sewing to the adjacent cervical muscles or pushed back in to the thoracic cavity. Pushing the anastomosis back into the thoracic cavity had significantly lowered the incidence of anastomotic leakage compared with the anastomosis being fixed in the cervical muscle (4.4% vs 11.4%, P = .027), because pushing the anastomosis back into the thorax could improve both the arterial blood perfusion and venous blood flow return theoretically.…”

“…Pushing the anastomosis back into the thoracic cavity had significantly lowered the incidence of anastomotic leakage compared with the anastomosis being fixed in the cervical muscle (4.4% vs 11.4%, P = .027), because pushing the anastomosis back into the thorax could improve both the arterial blood perfusion and venous blood flow return theoretically. [ 3 ]…”

“…Pushing the anastomosis back into the thoracic cavity had significantly lowered the incidence of anastomotic leakage compared with the anastomosis being fixed in the cervical muscle (4.4% vs 11.4%, P = .027), because pushing the anastomosis back into the thorax could improve both the arterial blood perfusion and venous blood flow return theoretically. [3] The cervical incision was for both gastro-esophageal anastomosis and surgical specimen extraction. After a gastric conduit was made using a linear stapler by dividing the stomach at the lesser curve under laparoscopy, the gastric conduit was pulled into the thoracic cavity through the hiatus, and the gastric specimen was still attached to the stomach fundus by a 3-cm-wide tissue to promote extraction of the specimen via the cervical incision.…”

“…[7][8][9] Nonetheless, the rate of leakage as a postoperative complication still varies from 4.0% to 20.5% in patients receiving intrathoracic anastomosis and from 12.3% to 31.0% in patients receiving cervical anastomosis. [3,[10][11][12] Intrathoracic leakage is more challenging because of the difficulty of adequate drainage and may result in severe infection before effective measure to heal the leakage. Thus, the MIE McKeown approach with cervical anastomosis may be more popular than that with intrathoracic anastomosis.…”