Clinical effect of modified esophagogastrostomy for prevention of reflux in the treatment of esophagogastric junction carcinoma by proximal gastrectomy

doi:10.3877/cma.j.issn.1674-3946.2022.04.015

Abstract

Abstract:

Objective

To investigate the clinical effect of modified esophagogastric stump anastomosis in the prevention of reflux in the treatment of adenocarcinoma of the esophagogastric junction（AEG）by proximal gastrectomy.

Methods

The clinical data of 60 AEG patients who underwent laparoscopic proximal gastric cancer resection from April 2020 to March 2021 were prospectively included. They were divided into two groups by random method，with 30 patients in each group. The semi-embedding group received semi-embedding flap anastomosis，and the two-channel group received two-channel anastomosis. SPSS 22.0 software was used for clinical data analysis. Perioperative indicators，GerdQ score and other measurement data were expressed by（

x ˉ

±s），and independent t test was used. Postoperative complications were counted by χ² test. P<0.05 was considered statistically significant.

Results

All 60 patients successfully completed the operation. The operation time and the first postoperative exhaust time of semi-embedding group were shorter than those of double-channel group（P<0.05）. The total incidence of complications in semi-embedding group within 1 month after surgery was lower than that in the double-channel group（P<0.05）. The GerdQ scores of patients of semi-embedding group were lower than those in dual-channel group at 7 and 14 days after surgery（P<0.05）.

Conclusion

The use of semi-embedded flap anastomosis in proximal gastrectomy for the treatment of esophagogastric junction carcinoma has the advantages of short operation time，quick postoperative recovery，fewer complications and significant anti-reflux effect，which is safe and feasible and can be promoted in clinical practice.

Key words: Adenocarcinoma of the esophagogastfic junction, Proximal gastrectomy, Semi-embedded flap anastomosis, Two-channel anastomosis, Comparative effectiveness research

Lei Ou, Zhiqian Luo, Wangwen Chen, Kaijun Long. Clinical effect of modified esophagogastrostomy for prevention of reflux in the treatment of esophagogastric junction carcinoma by proximal gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(04): 403-406.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.04.015

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2022/V16/I04/403

Figures/Tables 4

References 15

[1]	Mine S，Watanabe M，Kumagai K，et al. Comparison of mediastinal lymph node metastases from adenocarcinoma of the esophagogastric junction versus lower esophageal squamous cell carcinoma with involvement of the esophagogastric junction［J］. Dis Esophagus，2019，32（11）：doz002.
[2]	Cheng QS，Liu Y，Mei XH，et al. ［Current status of anti-reflux surgery of proximal gastrectomy for esophagogastric junction tumor］［J］. Zhonghua Wei Chang Wai Ke Za Zhi，2020，23（10）：1017-1022.
[3]	Zhao L，Ling R，Chen J，et al. Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer：A Systematic Review and Meta-Analysis［J］. Dig Surg，2021，38（1）：1-13.
[4]	吴昱朋. 食管胃结合部腺癌近端胃切除防反流手术方式的研究进展［J］. 中国微创外科杂志，2021，21（3）：272-277.
[5]	Zhao Y，Zhang J，Yang D，et al. Feasibility of laparoscopic total gastrectomy for advanced Siewert type Ⅱ and type Ⅲ esophagogastric junction carcinoma：A propensity score-matched case-control study［J］. Asian J Surg，2019，42（8）：805-813.
[6]	徐泽宽，徐皓，李铮. 全腹腔镜近端胃切除术的适应证及消化道重建方式的选择［J］. 中国肿瘤临床，2019，46（1）：12-15.
[7]	刘晓菊，姚芮. 近端胃切除术后两种消化道重建方式的安全性及生活质量对比研究［J/CD］. 中华普外科手术学杂志（电子版），2020，14（3）：285-288.
[8]	Trung LV，Loc NVV，Tien TPD，et al. Laparoscopic Proximal Gastrectomy with Jejunal Interposition for Early Proximal Gastric Cancer［J］. J Gastrointest Cancer，2021，52（2）：536-541.
[9]	Khan U，Shah MA. Ramucirumab for the treatment of gastric or gastro-esophageal junction cancer［J］. Expert Opin Biol Ther，2019，19（11）：1135-1141.
[10]	刘选文，李金秋，刘通，等. 双通道吻合技术在早期胃癌腹腔镜近端胃切除术消化道重建中的应用价值［J］. 腹腔镜外科杂志，2020，25（1）：21-24，29.
[11]	王伟，马从超，汤东，等. 空肠间置术在早期近端胃癌患者中应用效果评价［J/CD］. 中华普外科手术学杂志（电子版），2018，12（5）：414-417.
[12]	马飞，彭良群，刘长鹏，等. 完全腹腔镜与开放近端胃切除双通道吻合治疗SiewertⅡ、Ⅲ型食管胃结合部腺癌的疗效对比分析［J］. 中华胃肠外科杂志，2021，24（5）：420-425.
[13]	Wang B，Wu Y，Wang H，et al. Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction［J］. BMC Surg，2020，20（1）：230.
[14]	Wu Y，Zhang S，Wang L，et al. Comparative analysis of laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis with laparoscopic total gastrectomy for adenocarcinoma of the esophagogastric junction：a single-center retrospective cohort study［J］. World J Surg Oncol，2021，19（1）：50.
[15]	Omori T，Yamamoto K，Yanagimoto Y，et al. A Novel Valvuloplastic Esophagogastrostomy Technique for Laparoscopic Transhiatal Lower Esophagectomy and Proximal Gastrectomy for Siewert Type Ⅱ Esophagogastric Junction Carcinoma-the Tri Double-Flap Hybrid Method［J］. J Gastrointest Surg，2021，25（1）：16-27.

组别	例	性别	年龄 (岁)	BMI (kg/m²)		肿瘤直径 (cm)
组别	例	男/女	年龄 (岁)	BMI (kg/m²)		肿瘤直径 (cm)
半包埋组	30	17/13	63.8±7.2	23.6±1.3		3.2±1.4
双通道组	30	16/14	64.2±6.1	24.4±2.1		3.8±1.1
χ²/Z/t		0.067	-0.232	-1.774		-1.846
P		0.795	0.817	0.081		0.070
组别	例	Siewert分型	TNM分期		分化程度
组别	例	Ⅱ/Ⅲ	Ⅱ/Ⅲ/Ⅳ		低/中/高
半包埋组	30	11/19	14/10/6		8/8/14
双通道组	30	13/17	15/9/6		4/6/20
χ²/Z/t		0.228	0.193		-1.622
P		0.598	0.847		0.105

组别	例	性别	年龄 (岁)	BMI (kg/m²)		肿瘤直径 (cm)
组别	例	男/女	年龄 (岁)	BMI (kg/m²)		肿瘤直径 (cm)
半包埋组	30	17/13	63.8±7.2	23.6±1.3		3.2±1.4
双通道组	30	16/14	64.2±6.1	24.4±2.1		3.8±1.1
χ²/Z/t		0.067	-0.232	-1.774		-1.846
P		0.795	0.817	0.081		0.070
组别	例	Siewert分型	TNM分期		分化程度
组别	例	Ⅱ/Ⅲ	Ⅱ/Ⅲ/Ⅳ		低/中/高
半包埋组	30	11/19	14/10/6		8/8/14
双通道组	30	13/17	15/9/6		4/6/20
χ²/Z/t		0.228	0.193		-1.622
P		0.598	0.847		0.105

组别	例	手术时间(min)	术中出血量(ml)		淋巴结清扫数目(枚)
半包埋组	30	159.8±12.8	83.6±18.3		23.2±2.4
双通道组	30	168.5±16.3	98.1±20.6		23.4±2.3
t		-2.186	-1.981		-0.330
P		0.025	0.052		0.743
组别	例	住院时间（d）		术后首次排气时间（d）
半包埋组	30	11.9±2.0		2.9±0.8
双通道组	30	12.4±2.6		3.9±1.1
t		-0.835		-4.027
P		0.407		0.000

组别	例	手术时间(min)	术中出血量(ml)		淋巴结清扫数目(枚)
半包埋组	30	159.8±12.8	83.6±18.3		23.2±2.4
双通道组	30	168.5±16.3	98.1±20.6		23.4±2.3
t		-2.186	-1.981		-0.330
P		0.025	0.052		0.743
组别	例	住院时间（d）		术后首次排气时间（d）
半包埋组	30	11.9±2.0		2.9±0.8
双通道组	30	12.4±2.6		3.9±1.1
t		-0.835		-4.027
P		0.407		0.000

组别	例	反流	吻合口漏		吻合口狭窄		胃排空障碍
半包埋组	30	0（0.0）	0（0.0）		2（6.7）		0（0.0）
双通道组	30	3（10.0）	4（13.3）		0（0.0）		2（6.7）
χ²		-	-		-		-
P		-	-		-		-
组别	例	切口感染		肠梗阻		总并发症
半包埋组	30	0（0.0）		1（3.3）		3（10.0）
双通道组	30	2（6.7）		1（3.3）		12（33.3）
χ²		-		-		4.258
P		-		-		0.038

Please choose a citation manager

Content to export