title: [Antireflux anastomosis following resection of esophageal cancer].
abstract: OBJECTIVE
  To investigate the antireflux effects of a modified Nissen fundoplication following esophagectomy for cancer.
  
  
  METHODS
  From March 2006 to March 2007, 70 patients with esophageal cancer were divided into two groups randomly. Esophagogastrostomy with a stapler only was perform in 35 patients as controls (group C), and a modified Nissen fundoplication was added after esophagogastrostomy with stapler in the other 35 patients as observed group (group O). There were 48 male and 22 female, ranging in age from 47 to 77 years (mean 60.1 years). The operative morbidity and mortality were recorded. Fourty-nine patients were followed at 3 months after surgery, and the questionnaire of life quality (EORTC QLQ C-30) was conducted in 24 patients in group C and 25 patients in group O. Thirty patients were examined with esophageal manometry, 24 h pH monitoring and gastroscopy. There were 16 patients in group C and 14 patients in group O.
  
  
  RESULTS
  There was no significant difference in postoperative morbidity between the two groups (P > 0.05). However, the scores of heart burn and regurgitation in the group O were less than in group C (P = 0.041 and 0.034 respectively), but there was no difference in scores of dysphagia between the two groups (P = 0.677). The pressure at the anastomotic site was higher than that in the stomach in group O (P = 0.032), but not in group C (P = 0.448). DeMeester score in group O was 53 ± 46, compared to 140 ± 103 in group C (P = 0.043). The score of esophagitis was 0.9 ± 0.8 in group O, which was lower than 1.6 ± 1.0 in group C (P = 0.041).
  
  
  CONCLUSIONS
  Addition of modified Nissen fundoplication after esophagectomy and esophagogastrostomy for cancer significantly increases the pressure at the anastomotic site, thus reduces the extent of gastroesophageal reflux, which leads to the reduction of the extent of reflux esophagitis and the improvement of the quality of life.
authors.affiliation: Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China. liujf@heinfo.net
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Liu
authors.forename: Jin-Dong
authors.initials: JD
authors.lastname: Wang
authors.forename: Xin-Bo
authors.initials: XB
authors.lastname: Liu
authors.forename: Yong-Hui
authors.initials: YH
authors.lastname: Sun
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
authors.forename: Fu-Shun
authors.initials: FS
authors.lastname: Wang
authors.forename: Fu-Min
authors.initials: FM
authors.lastname: Cao
authors.forename: Bao-Qing
authors.initials: BQ
authors.lastname: Li
authors.forename: Qi-Zhang
authors.initials: QZ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D013270:Stomach / Q000601:surgery