Clinical Study Of Esophageal Resection And Cervical Side-to-side Esophagogastric Anastomosis

Objective: To probe the clinical effects and the application of the cervical side-to-side esophagogastric anastomosis.Method: 18 cases of upper and middle thoracic part esophageal carcinoma were treated with esophagectomy and cervical side-to-side esophagogastric anastomosis.The clinical data were collected and retrospectively analyzed.The average patient age was 60.7 yr old and the male to female ratio was 17:1.The tumors location included 4 cases of upper part and 14 cases of middle thoracic part.The tumors were 1 to 7cm long,with an average of 3.2cm. The operative technique consisted of total esophagectomy, gastric tube construction and cervical side-to-side esophagogastric anastomosis.First the esophagus was divided and the esophagectomy was done.Then the gastric tube was formed and pulled up to the left cervical area through the posterior mediastinum.The posterior wall of the divided esophagus was aligned to the anterior wall of the fundus of the gastric conduit for approximately 5 cm.A gastrotomy was made on the anterior gastric wall 5cm to the fundus of the gastric conduit.The side-to-side esophagogastric anastomosis was done with a 45mm endo-GIA stapler.The closure of the anterior anastomosis site was done by hand-sewn method within the hood of the overlying wall of the esophagus.Results: The operative staging(AJCC) included 4 cases of stageâ…¡a ,9 cases of stageâ…¡b and 5 cases of stageâ…¢.The operative incisions included 8 cases of nontransthoracic cervical and abdominal double incisions,9 cases of right cervico-thoraco- abdominal triple incisions and 1 case of left cervico-thoracic insions.1 case complicated with anastomotic leakage (5.56%) and was cured in two weeks by cervical drainage and absolute diet.All 18 cases were followed up over 1 year(1 to 5 years),No anastomotic stricture were found.Reflux esophagitis was found in 2 cases and the incidence rate was 11.11%.Conclusion: The cervical side-to-side esophagogastric anastomosis was a safe procedure with larger resection margins and lower incidence of the anastomotic site complications.It will have good use in the clinic.