The effect of narrowed gastric conduits on anastomotic leakage following minimally invasive oesophagectomy.
OBJECTIVE
Anastomotic leakage remains a major complication following minimally invasive oesophagectomy (MIO). In this study, our objective was to determine whether a narrower gastric conduit would lead to lower incidence of anastomotic leakage following MIO.


METHODS
In this retrospective study, patients with oesophageal cancer undergoing MIO were assigned to receive 5-cm-wide gastric conduits (from May 2011 to February 2012, Group W) and then 3-cm-wide gastric conduits (from March 2012 to December 2012, Group N) for gastro-oesophageal anastomosis. The length of the gastric conduit and the anastomotic details were recorded during surgery. Perfusion status of the conduit was analysed before and after anastomosis using a laser Doppler perfusion monitor. Following surgery, the incidence of anastomotic leakage in the two groups was statistically compared to identify differences between the two methods of gastric formation.


RESULTS
There were 126 patients in Group N and 133 patients in Group W. Patient demographics and surgical observations were comparable between the two groups. In Group N, the length of gastric conduit was significantly greater than in Group W (39.1 ± 2.7 vs 35.6 ± 4.4 cm, P = 0.0021). Lower reduction of perfusion units was recorded in Group N after gastro-oesophageal anastomosis (45.7 vs 28.1%, P = 0.004). Postoperatively, a total of 34 cases (13.13%) of anastomotic leakage was observed, and the incidence of anastomotic leakage was significantly lower in Group N than in Group W (8.7 vs 17.3%, P = 0.041).


CONCLUSIONS
Narrow gastric tubes were longer and less interfered in perfusion, which contributed to lower incidence of anastomotic leakage following minimally invasive oesophagectomy. Further study of the long-term effects of such treatment is required to confirm the advantages of this technique.
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Yaxing
Y
Shen
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Hao
H
Wang
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Mingxiang
M
Feng
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China tan.lijie@zs-hospital.sh.cn.
Lijie
L
Tan
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Qun
Q
Wang
D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*; D013906:Thoracoscopy / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
Anastomotic leakage; Gastric conduit; Minimally invasive oesophagectomy