Comparison Research Of Patients On Traditional Resection Of Esophageal Or Cardiac Carcinoma And Anti-Gastroesophageal Reflux Operation By Gastric Fundus Recombination With Remnant Stomach

ObjectiveBy comparing the postoperation gastroesophageal reflux and life quality of patients after traditional resection and anti-gastroesophageal reflux operation by gastric fundus recombination with remnant stomach, to explore the advantages of anti-gastroesophageal reflux operation and find more perfect surgical operation mode for patients with esophageal and cardiac carcinoma.Materials and MethodsForm January 2004 to December 2008, in patients with definite diagnosis of esophageal and cardiac carcinoma, 200 cases performed traditional resection of esophageal and cardiac carcinoma were collected as control group, whereas 240 cases performed anti-gastroesophageal reflux operation by gastric fundus recombination with remnant stomach were collected as antireflux group. There were 304 male cases and 136 female cases in two groups, age range 40-81 years old, and the average age was 57.5. All the cases were diagnosed as esophageal and cardiac carcinoma preoperatively by X-ray barium meal examination or endoscopic examination. The pathological reports after operations showed there were 220 cases of esophageal squamous carcinoma. In cardiac carcinoma patients, there were 158 cases of adencarcinoma, 48 cases of mucinous adenocarcinoma, 12 cases of signet-ring cell carcinoma and 2 cases of carcinoid. In the traditional resection of esophageal and cardiac carcinoma, tissues were resected 5cm from both the superior and inferior margin of the tumor, which means whole piece excised from the lower esophagus to the proximal stomach including the cardiac tumor. Then the remnant stomach was raised to thoracic cavity, the top of which was anastomosed with the lower esophagus to rebuild digestive tract. In the anti-gastroesophageal reflux operation by gastric fundus recombination with remnant stomach, the procedures of thoracotomy, tissues dissociation and tumor resection were same as the traditional operation mode. But the tissues along greater curvature of stomach should be retained as much as possible when resecting the tumor. Then the top of the remnant stomach was raised to left thoracic cavity. The lower esophagus was full-thickness anastomosed to the upper 1/3 of paries posterior gastricus, with the top of the remnant stomach fixed to the mediastinal pleura. Thus the upper 1/3 of remnant stomach was formed a new fundus gastricus at the left upper side of the anastomotic stoma. There was an included angle of 45 degree formed between the macroaxis of remnant stomach and esophagus. Then the fundus gastricus and His angle was rebuilded. Postoperative follow-up ranged 6 months to 5 years for all the cases including clinical symptom observation, X-ray upper gastrointestinal series observing reflux states and fiberoptic gastroscopy detecting oedema, ulcer and haemorrhage of tunica mucosa esophagi. Some patients checked with radionuclide after 18 to 20 days of surgery. Some patients in antireflux group had 24-hour monitoring of pH in the remnant esophageal cavities after 1 to 3 months of surgery.ResultsThere were 46 cases with obvious refluxing symptom in control group (23.0%, 46/200) whereas 16 cases in antireflux group (6.7%, 16/240). For X-ray upper gastrointestinal series, 72 cases in control group had positive results of gastroesophageal reflux (36.0%, 72/200), while 24 cases in antireflux group (10.0%, 24/240). There were 38 cases in control group (19.0%, 38/200) detected oedema, anabrosis ulcer and haemorrhage of tunica mucosa esophagi under gastroscopy whereas 12 cases in antireflux group (5.0%, 12/240). The postoperative reflux cases of antireflux group was significantly reduced compared with control group (P<0.05). The incidence of reflux determined by X-ray barium meal and endoscopy was higher than clinical symptom, suggesting patients with no obvious symptom could also have gastroesophageal reflux.ConclusionsThe anti-gastroesophageal reflux operation by gastric fundus recombination with remnant stomach could utilize the tissues of remnant stomach in maximum and resect the tumor thoroughly at the same time, so the normal tissue and function of stomach could be retained as much as possible. This operation mode could also reduce the incidence of postoperative belching. All these suggesting it's effective to anti reflux and improve the life quality of patients. So the anti-gastroesophageal reflux operation by gastric fundus recombination with remnant stomach could be used as an ideal operation mode for routine resection of esophageal or cardiac carcinoma.