Correlation between anastomotic angle and postoperative anastomotic stricture in the surgery of esophageal carcionma: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 XIONG Jian ¹ , ZHENG Chunhui ² ,  XU Yongdong ^1,2

1. Department of Thoracic Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, P.R.China;
2. Department of Thoracic Surgery, Lishui Central Hospital, Lishui Hospital Affiliated to Zhejiang University, Lishui, 323000, Zhejiang, P.R.China;

Corresponding author：

XU Yongdong, Email: xyd927927@163.com

Keywords：

Esophageal carcinoma; anastomotic angle; anastomotic stricture

DOI：

10.7507/1007-4848.201612061

Video：

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Objective To investigate the correlation between end-to-side anastomotic angle and postoperative anastomotic stricture in the surgery of esophageal carcinoma. Methods From January 2011 to June 2015, 130 patients with middle/lower esophageal carcinoma or gastric cardia cancer underwent operations in Shanghai Pudong Hospital and Lishui Central Hospital, Zhejiang Province. Depending on the end-to-side anastomotic angle, they were randomly divided into two groups (n=65 in each): a 0 degree group (49 males and 16 females, aged 64.5±8.3 years) and a 45 degrees group (52 males, 13 females, aged 61.7±9.1 years). Stooler degree grading was adopted to evaluate the anastomotic stricture in each group 6 months postoperatively. Results There were two patients with anastomotic fistula in each group (P>0.05). Pathology showed squamous carcinoma in 116 patients and adenocarcinoma in 14 patients. The postoperative esophageal stricture in the 45 degrees group was significantly less than that in the 0 degree group. There was no statistical difference in the duration of chest tube (5.9±6.7 dvs. 5.8±6.8 d) and recovery of intestinal peristalsis (2.6±0.8 d vs.2.6±0.7 d) between the 45 degrees group and the 0 degree group. Conclusion Esophagogastric anastomotic angle is related to the formation of postoperative anastomotic stricture. Oblique anastomosis with 45 degrees is helpful to decrease the severity of stricture.

Citation： XIONG Jian, ZHENG Chunhui, XU Yongdong. Correlation between anastomotic angle and postoperative anastomotic stricture in the surgery of esophageal carcionma: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 947-951. doi: 10.7507/1007-4848.201612061 Copy

1.	Nozaki I, Hato S, Yamashita M, et al. Hand-sewn anastomotic technique after esophageal cancer resection. Hepatogastroenterology, 2014, 61(135): 1957-1960.
2.	Takemura M, Yoshida K, Fujiwara Y. Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc, 2013, 27(4): 1249-1253.
3.	Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis, 2015, 7(12): 2352-2358.
4.	Irino T, Tsai JA, Ericson J, et al. Thoracoscopic side-to-side esophagogastrostomy by use of linear stapler-a simplified technique facilitating a minimally invasive Ivor-Lewis operation. Langenbecks Arch Surg, 2016, 401(3): 315-322.
5.	Chen S, Li J, Liu H, et al. Esophagogastrostomy plus gastrojejunostomy: A novel reconstruction procedure after curative resection for proximal gastric cancer. J Gastrointest Surg, 2014, 18(3): 497-504.
6.	Jia R, Guo R, Liu G, et al. Evaluation of combined argon plasma coagulation and Savary Bougienage for the relief of anastomotic-stenosis after esophageal squamous cancer surgery. Dig Surg, 2014, 31(6): 415-421.
7.	Chen L, Liu X, Wang R, et al. Minimally invasive esophagectomy for esophageal cancer according to the location of the tumor: Experience of 251 patients. Ann Med Surg (Lond), 2017, 17: 54-60.
8.	胡运彪. 食管狭窄的扩张治疗. 内镜, 1991, 8: 15.
9.	Maus MK, Leers J, Herbold T, et al. Gastric outlet obstruction after esophagectomy: retrospective analysis of the effectiveness and safety of postoperative endoscopic pyloric dilatation. World J Surg, 2016, 40(10): 2405-2411.
10.	Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997, 226(2): 169-173.
11.	Feng F, Sun L, Xu G, et al. Albert-Lembert versus hybrid-layered suture in hand sewn end-to-end cervical esophagogastric anastomosis after esophageal squamous cell carcinoma resection. J Thorac Dis, 2015, 7(11): 1917-1926.
12.	Wu S, Chen M, Wei L, et al. Embedded cervical esophagogastrostomy: a simple and convenient method using a circular stapler after esophagectomy for esophageal carcinomas. Ann Surg Oncol, 2013, 20(9): 2984-2990.
13.	Umemura A, Koeda K, Sasaki A, et al. Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg, 2015, 38(2): 102-112.
14.	Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5): 1043-1050.
15.	Van Workum F, van der Maas J, van den Wildenberg FJ, et al. Improved Functional Results After Minimally Invasive Esophagectomy: Intrathoracic Versus Cervical Anastomosis. Ann Thorac Surg, 2017, 103(1): 267-273.
16.	Orringer, Marshall, Iannettoni. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2): 277-288.
17.	Ben-David K, Tuttle R, Kukar M, et al. Minimally Invasive Esophagectomy Utilizing a Stapled Side-to-Side Anastomosis is Safe in the Western Patient Population. Ann Surg Oncol, 2016, 23(9): 3056-3062.
18.	Haverkamp L, Seesing MF, Ruurda JP, et al. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus, 2017, 30(1): 1-7.
19.	Johansson J, Oberg S, Wenner J, et al. Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial.Ann Surg, 2009, 250(5): 667-673.

1. Nozaki I, Hato S, Yamashita M, et al. Hand-sewn anastomotic technique after esophageal cancer resection. Hepatogastroenterology, 2014, 61(135): 1957-1960.
2. Takemura M, Yoshida K, Fujiwara Y. Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc, 2013, 27(4): 1249-1253.
3. Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis, 2015, 7(12): 2352-2358.
4. Irino T, Tsai JA, Ericson J, et al. Thoracoscopic side-to-side esophagogastrostomy by use of linear stapler-a simplified technique facilitating a minimally invasive Ivor-Lewis operation. Langenbecks Arch Surg, 2016, 401(3): 315-322.
5. Chen S, Li J, Liu H, et al. Esophagogastrostomy plus gastrojejunostomy: A novel reconstruction procedure after curative resection for proximal gastric cancer. J Gastrointest Surg, 2014, 18(3): 497-504.
6. Jia R, Guo R, Liu G, et al. Evaluation of combined argon plasma coagulation and Savary Bougienage for the relief of anastomotic-stenosis after esophageal squamous cancer surgery. Dig Surg, 2014, 31(6): 415-421.
7. Chen L, Liu X, Wang R, et al. Minimally invasive esophagectomy for esophageal cancer according to the location of the tumor: Experience of 251 patients. Ann Med Surg (Lond), 2017, 17: 54-60.
8. 胡运彪. 食管狭窄的扩张治疗. 内镜, 1991, 8: 15.
9. Maus MK, Leers J, Herbold T, et al. Gastric outlet obstruction after esophagectomy: retrospective analysis of the effectiveness and safety of postoperative endoscopic pyloric dilatation. World J Surg, 2016, 40(10): 2405-2411.
10. Law S, Fok M, Chu KM, et al. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg, 1997, 226(2): 169-173.
11. Feng F, Sun L, Xu G, et al. Albert-Lembert versus hybrid-layered suture in hand sewn end-to-end cervical esophagogastric anastomosis after esophageal squamous cell carcinoma resection. J Thorac Dis, 2015, 7(11): 1917-1926.
12. Wu S, Chen M, Wei L, et al. Embedded cervical esophagogastrostomy: a simple and convenient method using a circular stapler after esophagectomy for esophageal carcinomas. Ann Surg Oncol, 2013, 20(9): 2984-2990.
13. Umemura A, Koeda K, Sasaki A, et al. Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg, 2015, 38(2): 102-112.
14. Wang WP, Gao Q, Wang KN, et al. A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg, 2013, 37(5): 1043-1050.
15. Van Workum F, van der Maas J, van den Wildenberg FJ, et al. Improved Functional Results After Minimally Invasive Esophagectomy: Intrathoracic Versus Cervical Anastomosis. Ann Thorac Surg, 2017, 103(1): 267-273.
16. Orringer, Marshall, Iannettoni. Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg, 2000, 119(2): 277-288.
17. Ben-David K, Tuttle R, Kukar M, et al. Minimally Invasive Esophagectomy Utilizing a Stapled Side-to-Side Anastomosis is Safe in the Western Patient Population. Ann Surg Oncol, 2016, 23(9): 3056-3062.
18. Haverkamp L, Seesing MF, Ruurda JP, et al. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus, 2017, 30(1): 1-7.
19. Johansson J, Oberg S, Wenner J, et al. Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial.Ann Surg, 2009, 250(5): 667-673.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Correlation between anastomotic angle and postoperative anastomotic stricture in the surgery of esophageal carcionma: A randomized controlled trial

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