title: Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage.
abstract: BACKGROUND
  Esophagectomy through cervico-thoraco-abdominal approach is a useful surgical technique in treating patients with esophageal cancer. However, the cervical reconstruction is also known to have a high rate of anastomotic leakage, as well as anastomotic stricture, intrathoracic stomach syndrome, reflux esophagitis and other complications, thereby influencing postoperative recovery and quality of life.
  
  
  OBJECTIVE
  The objective of this study was to investigate whether tubular stomach is superior to whole stomach in reducing anastomotic leakage for esophageal reconstruction through the cervico-thoraco-abdominal (3-field) approach.
  
  
  METHODS
  A total of 850 patients undergoing the 3-field esophagectomy were retrospectively included in this study and divided into a tubular stomach reconstruction group (Group A, n=453) and a whole stomach reconstruction group (Group B, n=397). All patients underwent esophagectomy through right thorax, left cervical part, abdominal triple incisions and done in esophageal reconstruction by hand-sewn two-layer anastomosis.
  
  
  RESULTS
  Results revealed that in comparison with whole stomach, esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage (5.5 vs. 9.3%, P<0.05), less manifestation of intrathoracic syndrome (3.3 vs. 9.8%, P<0.001) and less occurence of reflux esophagitis (5.1 vs. 11.1%, P<0.01). However, for the incidence of anastomotic stricture, there was no significant difference between the two groups (9.3 vs. 9.8%).
  
  
  CONCLUSIONS
  This observation study suggests that for esophageal cancer patients undergoing the 3-field esophagectomy tubular stomach is better than whole stomach for esophageal reconstruction as reflected by a reduced postoperative anastomotic leakage, intrathoracic syndrome and reflux esophagitis.
authors: Department of Cardiothoracic Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 98 West Nantong Road, Yangzhou, 225001, Jiangsu Province, China. shuyusheng65@163.com
authors: Y-S
authors: YS
authors: Shu
authors: C
authors: C
authors: Sun
authors: W-P
authors: WP
authors: Shi
authors: H-C
authors: HC
authors: Shi
authors: S-C
authors: SC
authors: Lu
authors: K
authors: K
authors: Wang
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome
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