Objective To evaluate preventive effectiveness of pocket esophagogastric anastomosis for postoperativeanastomotic leak，stricture and gastroesophageal reflux disease （GERD），and investigate clinical significance of Montreal definition and classification of GERD after esophageal reconstruction. Methods Clinical data of 1 078 patients whoreceived 2 different surgical procedures for resection of esophageal or cardiac carcinoma from June 2007 to June 2011 in our hospital were retrospectively analyzed. In the experimental group，there were 582 patients who received pocketesophagogastric anastomosis，including 403 male and 179 female patients with their age of 60.4±12.6 years. There were 399 patients with esophageal carcinoma and 183 patients with cardiac carcinoma，392 patients receiving esophagogastrostomyabove the aortic arch and 190 patients receiving esophagogastrostomy below the aortic arch respectively. In the control group，there were 496 patients who received conventional end-to-side esophagogastric anastomosis，including 343 male and 153 female patients with their age of 59.2±12.8 years. There were 322 patients with esophageal carcinoma and 174 patients with cardiac carcinoma，317 patients receiving esophagogastrostomy above the aortic arch and 179 patients receivingesophagogastrostomy below the aortic arch respectively. A survey questionnaire was made on the basis of relevant diagnosticstandards to investigate the incidence of postoperative anastomotic stricture and GERD of the 2 groups during follow-up.Results The incidence of postoperative anastomotic leak of the experimental group was significantly lower than that of the control group ［0% （0/582）versus 1.0% （5/496），χ2=5.835，P=0.016］. Patients in the experimental group had less severeGERD symptoms，and the percentage of patients who needed antacid therapy for extraesophageal symptoms of GERD ofthe experimental group was significantly lower than that of the control group ［1.6% （33/541） versus 12.6% （57/453），χ2=23.564，P=0.000］. The incidence of anastomotic stricture of the experimental group was significantly lower than that of thecontrol group ［0.9% （5/539） versus 7.3% （34/465），χ2=25.124，P=0.000］，and especially，the incidence of severe anastomoticstricture of the experimental group was significantly lower than that of the control group ［0% （0/539） versus 4.7% （22/465），χ2=24.883，P=0.000］. There was no statistical difference in five-year survival rate. Conclusion Pocket esophagogastric anastomosis is better than conventional end-to-side esophagogastric anastomosis for the prevention of postoperative anastomoticleak，stricture and GERD. Montreal definition and classification of GERD is suitable for the diagnosis of postoperativeGERD after esophageal reconstruction.
Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy. Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012), EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, Plt;0.01). Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.