Comparative Study Of T Shaped Cervical Anastomosis And Circular Stapled Cervical Anastomosis For Thoracolaparoscopic Radical Resection Of Esophageal Cancer

Objective The high incidence of complications after esophagectomy has always been a difficult problem for thoracic surgeons,which also has a great impact on the prognosis,quality of life and physical and mental health of patients The postoperative complications of esophageal cancer may be related to the choice of anastomosis mode of esophagus-gastroesophagus in esophagectomy,especially the anastomotic complications.In this study,we compared the intraoperative and postoperative indicators of T shaped cervical anastomosis(TSA)and conventional circular stapled cervical anastomosis(CSA)in thoracoscopic and laparoscopic minimally invasive esophagectomy(MIE)radical treatment of esophageal cancer in cervical anastomosis,and analyze the clinical effects of the two anastomotic methods.Method Retrospectively analyzed the clinical data and postoperative follow-up data of 68 cases of middle and upper esophageal squamous cell carcinoma admitted to the department of thoracic surgery in our hospital from September 2016 to January 2018.All patients underwent gastroscopy,plain combined with enhanced CT scan of the cervicothoracic and upper abdomen,upper gastrointestinal radiography,and confirmedpathological diagnosis and preoperative staging.All patients underwent thoracolaparoscopic Radical Resection of Esophageal Cancer,cervical Anastomosis and lymph node dissection.According to the different cervical anastomosis,they were divided into two groups: T shaped anastomosis(TSA)group and circular stapled anastomosis(CSA).There were 32 patients in the TSA group,including 26 males and 6females,with an average age of(62.81±8.20)years.There were 36 patients in the CSA group,including 30 males and 6 females,with an average age of(62.08±8.34)years.The anastomotic time,intraoperative blood loss,cardiopulmonary complications and anastomotic complications were recorded.SPSS 22.0 statistical software was used for statistical analysis.Results All patients successfully completed the operation and no perioperative death cases.In the TSA group,the anastomotic time was(20.31±5.23)min,intraoperative blood loss was(256.88 ± 61.77)ml,postoperative anastomotic fistula occurred in 2cases(6.25%),anastomotic stenosis in 1 case(3.13%),gastroesophageal reflux in 14cases(43.75%),pulmonary infection in 5 cases(15.62%),and arrhythmia in 3 cases(9.38%).In the CSA group,the anastomotic time was(21.19±4.25)min,intraoperative blood loss was(257.22 ± 65.01)ml,postoperative anastomotic fistula occurred in 2cases(5.56%),anastomotic stenosis in 9 cases(25.00%),gastroesophageal reflux in 17cases(44.74%),pulmonary infection in 7 cases(19.44%),and pulmonary infection in 2cases(5.56%).There were no statistically significant differences between the two groups in anastomotic time,intraoperative blood loss,postoperative anastomotic fistula,gastroesophageal reflux,pulmonary infection and arrhythmia(P>0.05),while the incidence of postoperative anastomotic stenosis in TSA group was significantly lower than that in CSA group(P < 0.05).Conclusion Compared with CSA,the TSA can reduce the incidence of anastomotic stenosis in thoracolaparoscopic radical resection of esophageal cancer with cervicalanastomosis,and does not increase the anastomotic time,intraoperative blood loss,postoperative anastomotic fistula incidence and gastroesophageal reflux incidence.In conclusion,thoracolaparoscopic radical resection of esophageal cancer with T shaped cervical anastomosis has good safety and clinical effect,which is a kind of esophagogastric anastomosis worthy of promotion.