Different anastomotic techniques in inflatable mediastinoscopy with laparoscopy radical esophageal cancer surgery: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Baoli ¹ , SUN Xiang ² , ZHU Ziyin ² , YAO Shuhuan ² , ZHANG Haifeng ² , LI Xiapeng ² , WEI Haitao ² ,  LI Li ^1,2 ,  LIU Lu ³

1. Department of Thoracic Surgery, Huaihe Hospital, Henan University, Kaifeng, 475001, Henan, P. R. China;
2. Chronic Disease Research Institute, School of Nursing and Health, Henan University, Kaifeng, 475001, Henan, P. R. China;
3. Department of Respiratory Medicine, Huaihe Hospital, Henan University, Kaifeng, 475001, Henan, P. R. China;

Corresponding author：

LI Li, Email: 10210051@vip.henu.edu.cn; LIU Lu, Email: 258096@henu.edu.cn

Keywords：

Inflatable mediastinoscopy synchronized laparoscopy; radical esophageal cancer surgery; hand-sewn layered anastomosis; circular stapler anastomosis; pulmonary function; complications

DOI：

10.7507/1007-4848.202507078

Video：

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Objective To explore the application effects of hand-sewn layered anastomosis (HS) and circular stapled anastomosis (CS) in inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer. Methods Patients who underwent inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer in Huaihe Hospital of Henan University from 2018 to 2019 were retrospectively included. Patients were divided into a HS group and a CS group according to the anastomosis methods, and propensity score matching was used to match patients at a ratio of 1:1. The baseline clinical characteristics, perioperative indicators, CD4⁺/CD8⁺ immune index comparison, pain, various lung function indicators, incidence of short-term and long-term postoperative complications, and quality of life were compared between the two groups. Results A total of 153 patients were included, including 108 males and 45 females, with an average age of (61.81±5.18) years. After propensity score matching, 70 patients were included in each group. Compared with the CS group, the operation time was longer in the HS group [(107.10±8.25) min vs. (97.65±6.85) min, P<0.001]; the CD4⁺/CD8⁺ level was lower in the HS group 1-3 days after surgery; the pain score was higher, and various lung function indicators (forced expiratory volume in the first second, forced vital capacity, and one-second rate) were lower in the HS group 1-7 days after surgery; within 6 months after surgery, the incidence of anastomosis-related complications (anastomotic stenosis, anastomotic fistula, and gastroesophageal reflux) was lower in the HS group; and the quality of life score was higher in the HS group from 14 days to 6 months after surgery (P<0.05). Conclusion HS can reduce the incidence of postoperative anastomotic fistula, anastomotic stenosis, and gastroesophageal reflux, and improve the short-term quality of life of patients, but it has a longer operation time, more intense short-term postoperative pain, and may affect the early recovery of lung function. HS and CS are complementary, and the appropriate surgical method should be chosen according to the individual situation of the patient to achieve the maximum clinical benefit.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Yang H, Wang F, Hallemeier CL, et al. Oesophageal cancer. Lancet, 2024, 404(10466): 1991-2005.
3.	Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
4.	Zhang W, Cui D, Shi K, et al. Feasibility and safety of expandable mediastinoscopic and laparoscopic radical esophagectomy. Front Oncol, 2023, 13: 1110962.
5.	Vercoulen R, van Veenendaal L, Kramer IF, et al. Minimally Invasive transCervical oEsophagectomy (MICE) for oesophageal cancer: prospective cohort study (IDEAL stage 2A). Br J Surg, 2024, 111(7): znae160.
6.	Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs, 2005, 14(7): 798-804.
7.	Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
8.	Fayers P, Bottomley A. Quality of life research within the EORTC-the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer. Eur J Cancer, 2002, 38(Suppl 4): S125-S133.
9.	Jamal A, Aldreiwish AD, Banawas SS, et al. The paths toward immunotherapy of esophageal cancer: an overview of clinical trials. Int Immunopharmacol, 2025, 151: 114261.
10.	Iwakiri K, Fujiwara Y, Manabe N, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021. J Gastroenterol, 2022, 57(4): 267-285.
11.	Fujiwara H, Shiozaki A, Konishi H, et al. Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve. Ann Thorac Surg, 2015, 100(3): 1115-1117.
12.	Fujiwara H, Shiozaki A, Konishi H, et al. Hand-assisted laparoscopic transhiatal esophagectomy with a systematic procedure for en bloc infracarinal lymph node dissection. Dis Esophagus, 2016, 29(2): 131-138.
13.	Qureshi S, Khan S, Waseem HF, et al. Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: an experience from a low middle-income country. Asian J Surg, 2024, 47(1): 425-432.
14.	Hua F, Sun D, Zhao X, et al. Update on therapeutic strategy for esophageal anastomotic leak: a systematic literature review. Thorac Cancer, 2023, 14(4): 339-347.
15.	Müller DT, Babic B, Herbst V, et al. Does circular stapler size in surgical management of esophageal cancer affect anastomotic leak rate? 4-year experience of a European high-volume center. Cancers (Basel), 2020, 12(11): 3474.
16.	李滔, 蒋运兰, 康静, 等. 食管癌根治术后吻合口瘘发生风险预测模型的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2025, 32(3): 385-392.Li T, Jiang YL, Kang J, et al. Systematic review and Meta-analysis of risk prediction models for anastomotic leakage after radical resection of esophageal cancer. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 385-392.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Yang H, Wang F, Hallemeier CL, et al. Oesophageal cancer. Lancet, 2024, 404(10466): 1991-2005.
3. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
4. Zhang W, Cui D, Shi K, et al. Feasibility and safety of expandable mediastinoscopic and laparoscopic radical esophagectomy. Front Oncol, 2023, 13: 1110962.
5. Vercoulen R, van Veenendaal L, Kramer IF, et al. Minimally Invasive transCervical oEsophagectomy (MICE) for oesophageal cancer: prospective cohort study (IDEAL stage 2A). Br J Surg, 2024, 111(7): znae160.
6. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs, 2005, 14(7): 798-804.
7. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286-294.
8. Fayers P, Bottomley A. Quality of life research within the EORTC-the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer. Eur J Cancer, 2002, 38(Suppl 4): S125-S133.
9. Jamal A, Aldreiwish AD, Banawas SS, et al. The paths toward immunotherapy of esophageal cancer: an overview of clinical trials. Int Immunopharmacol, 2025, 151: 114261.
10. Iwakiri K, Fujiwara Y, Manabe N, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021. J Gastroenterol, 2022, 57(4): 267-285.
11. Fujiwara H, Shiozaki A, Konishi H, et al. Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve. Ann Thorac Surg, 2015, 100(3): 1115-1117.
12. Fujiwara H, Shiozaki A, Konishi H, et al. Hand-assisted laparoscopic transhiatal esophagectomy with a systematic procedure for en bloc infracarinal lymph node dissection. Dis Esophagus, 2016, 29(2): 131-138.
13. Qureshi S, Khan S, Waseem HF, et al. Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: an experience from a low middle-income country. Asian J Surg, 2024, 47(1): 425-432.
14. Hua F, Sun D, Zhao X, et al. Update on therapeutic strategy for esophageal anastomotic leak: a systematic literature review. Thorac Cancer, 2023, 14(4): 339-347.
15. Müller DT, Babic B, Herbst V, et al. Does circular stapler size in surgical management of esophageal cancer affect anastomotic leak rate? 4-year experience of a European high-volume center. Cancers (Basel), 2020, 12(11): 3474.
16. 李滔, 蒋运兰, 康静, 等. 食管癌根治术后吻合口瘘发生风险预测模型的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2025, 32(3): 385-392.Li T, Jiang YL, Kang J, et al. Systematic review and Meta-analysis of risk prediction models for anastomotic leakage after radical resection of esophageal cancer. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 385-392.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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