[Application of gastroepiploic tunnel esophagogastrostomy in minimally invasive esophagectomy].
OBJECTIVE
To explore the clinical efficacy and safety of gastroepiploic tunnel esophagogastrostomy applied in minimally invasive esophagectomy and gastroesophageal cervical anastomosis.


METHODS
Clinical data of 137 esophageal cancer patients who received minimally invasive esophagectomy from December 2013 to June 2015 in Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University were analyzed retrospectively, including 84 patients receiving anastomosis with tubular anastomat (circular staple group), and 53 patients receiving gastroepiploic tunnel anastomosis(tunnel group, position of tunnel anastomosis located in the side of gastrocolic omentum, about 2-3 cm apart from fundus). Incidence of postoperative anastomotic leakage and stricture was compared between two groups.


RESULTS
All the 137 patients completed minimally invasive esophageal surgeries successfully without conversion to open thoracic or abdominal operation. The time for anastomosis was(20.2±3.1) minutes in circular stapler group and (38.9±2.9) minutes in tunnel group respectively, and the difference was statistically significant (t=75.22, P=0.000 0). The incidence of postoperative anastomotic leakage was 21.4%(18/84) in circular stapler group and 0(0/53) in tunnel group respectively, and the difference was statistically significant (P=0.000 3). All the patients were followed up for more than 6 months. During follow-up period, the incidence of postoperative anastomotic stricture was 14.3%(12/84) in circular stapler group and 3.8%(2/53) in tunnel group respectively, and the difference was statistically significant(P=0.047 9).


CONCLUSIONS
The gastroepiploic cervical tunnel anastomosis is safe and effective and can reduce the incidence of postoperative anastomotic leakage as well as anastomotic stricture.
Lin
L
Zhou
Peng
P
Ge
Jiakuan
J
Chen
Jian
J
Wang
Ming
M
Wang
Xiaofei
X
Li
Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China. jiangtaochest@163.com.
Tao
T
Jiang
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000517:prevention & control*; D057186:Comparative Effectiveness Research; D003251:Constriction, Pathologic / Q000453:epidemiology* / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D004944:Esophagoplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009333:Neck / Q000601:surgery; D009852:Omentum; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods