Technique Of Esophagogastric T-shaped Side To Side Stapled Anastomosis In Minimally Invasive Esophagectomy

Part 1:Technique of Esophagogastric T-shaped Side-to-Side Stapled Anastomosis in Thoracoscopic and Laparoscopic Esophagectomy:A Series of 108 casesObjective:To evaluate the clinal effect of esophagogastric T-shaped side-to-side stapled anastomosis in thoracoscopic and laparoscopic resection of esophageal carcinoma.Methods:From January 2015 to June 2018,we randomly selected a part of patients with esophageal carcinoma in our department,whom received thoracoscopic and laparoscopic esopagectomy and using the the esophagogastric T-shaped side-to-sid stapled anastomosis technique.We retrospectively analyzed the clinical date of these patients.Results:A total of 108 patients were enrolled,locations of the tumors includedupper esophagus(n=30),middle esophagus(n=50),and lower esophagus(n=28).The t-umor staging patients in stage I(n=5),IIA(n=50),IIB(n=33),Ⅲ(n=20).The anastomosis location were 26 cases in right thoracic and 82 cases in left cervical.By The end of July-2018,a total of 30 patients had a tumor recurrence(30/108)and 7 patients were died.7 patients occurred anastomotic leakage.1 patient occurred postoperation anastomotic stenosis and finally received endoscopic dilatation treatment.Conclusion:The technique of esophagogastric T-shaped side-to-side stapled anast-omosis in thoracoscopic and laparoscopic esophagectomy with a low incidence of anastomotic fistula,almost no anastomotic stricture,less immediate and long-term complications.The techique is a safe and effective method for the treatment of esopha-geal carcinoma.Part 2:Comparative analysis of esophagogastric T-shaped side to side stapled anastomosis in chest and neckObjective:To compare the effect of esophagogastric T-shaped side to side stap 1-ed anastomosis in diffent anastomos locationMethods:From January 2015 to June 2018,108 patients who underwent minimally invasive esophagectomy were divided into two group according to the anastomosis location,right intrathoracic anastomosis group and left cervical anastomosis group,the right intrathoracic anastomosis group including 26 cases,the left cervical anastomosis group and including 26 cases.We retrospective analysis the clinal date,such as operation time,complications and long-term survival after operation,and et al.Results:All patients completed minimally invasive esophagectomy successfully without convert to thoracotomy.There were 26 cases of right intrathoracic anastomosis and 82 cases of left cervical anastomosis.All patients were accepted T-shaped side to side stapled anastomosis technique.There was no significant difference in operative time,intraoperative bleeding and postoperative hospital stay between the two groups(P>0.05).The average number of dissected lymph nodes and upper mediastinal lymph nodes in the right thoracic anastomosis group were less than those in the left cervical T-shaped anastomosis group,but there was no significant difference in the total metastasis rate between the two groups(P>0.05).There was no significant difference in the cost of operation and total hospitalization between the two groups(P>0.05).The incidence of recurrent laryngeal nerve injury and anastomotic leakage in right intrathoracic T-shaped anastomosis group was lower than that in left cervical T-shaped anastomosis group(P<0.05).There were no significant differences in postoperative arrhythmia,pneumonia,incision infection,chylothorax and drainge between the two groups(P>0.05).A total of 108 patients(100%)were followed up in the two groups.The deadline for follow-up was August 2018.The follow-up period ranged from 1 to 42 months with a median follow-up period of 20 months.All stage I patients received no chemotherapy,and all stage II and III patients received standard 4-6 doses of gemcitabine plus nedaplatin.The local recurrence or distant metastasis rates,reflux esophagitis,anastomosis stenosis,recurrence-free survival rate,total mortality and overall survival rate were followed up.There was no significant difference between the two groups except that the cervical anastomosis of reflux esophagitis was less than that of right thoracic esophagitis(p<0.05).Conclusion:These comparative studies confirmed that T-shaped side to side stapled anastomosis technique was safe and feasible in both right thoracic and left cervical,and both groups were able to thoroughly dissect regional lymph nodes.Compared with left cervical anastomosis,right intrathoracic T-shaped side to side stapled anastomosis has lower complications in postoperative anastomotic leakage,left and right recurrent laryngeal nerve injury,and lower left cervical reflux esophagitis.There were no significant differences in other short-term and long-term complications between the two groups.Using the technique in minimally invasive esophagectomy is safe,feasible and effective.Part 3:Comparison of T-shaped side to side stapled anastomosis and circular stapled anastomosis in left cervical after thoracoscopic and laparoscopic esophagectomyObjective:To compare the outcomes between T-shaped side to side stapled anastomosis and circular stapled anastomosis in left cervical after thoracoscopic and laparoscopic esophagectomy.Methods:A prospective randomized controlled trial was undertaken in 406 pati-ents undergoing minimally invasive Meckown esophagectomy(MIME)in our department between January 2015 to June 2018.Patients were randomized to receive either T-shaped side to side stapled anastomosis(TSA)and circular stapled anastomosis(CSA)in left cervical after thoracoscopic and laparoscopic esophagectomy,analysing the operating time of anastomosis,length of stay and the postoperative complications.Results:There was no significant difference between the 2 groups in the length of hospital stay,the mortality and the incidence of postoperative complications,anastomotic leakage and anastomotic reflux(P>0.05).The TSA group was associated with significantly fewer operating time of anastomosis,more larger diameter of anastomotic in one month and three months after the operation,lower incidence of anastomotic stenosis(P<0.05)than the CSA group.Furthermore,it was showed that the incidence of anastomotic stenosis which not followed anastomotic leakage in the TSA group was obviously lower than that in the CSA group(P<0.01)Conclusion:The technique of TSA is simply and convenient,shortens the time of anastomosis and obviously reduces the incidence of benign anastomotic stenosis.