The safety of esophagojejunostomy via a transorally inserted-anvil method vs extracorporeal anastomosis using a circular stapler during total gastrectomy for Siewert type 2 adenocarcinoma of the esophagogastric junction  

对比经口置入砥钉座方法进行食管空肠吻合与使用圆形吻合器进行腔外吻合应用于Siewert 2型食管胃结合部腺癌全胃切除后消化道重建的安全性

作　　者：Xin-Hua Chen Yan-Feng Hu Jun Luo Yue-Hong Chen Hao Liu Tian Lin Hao Chen Guo-Xin Li Jiang Yu 

机构地区：[1]Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong,P.R.China

出　　处：《Gastroenterology Report》2020年第3期242-251,I0002,共11页胃肠病学报道（英文）

基　　金：This work was supported by Medtronic,National Key Clinical Specialities Construction Program of China[No.[2012]121];Science and Technology Planning Project of Guangdong Province[2013B021800313];Special Funds for the Cultivation of Guangdong College Students’Scientific and Technological Innovation[pdjha0094].

摘　　要：Background:Intracorporeal esophagojejunostomy via a transorally inserted-anvil method during laparoscopic total gastrectomy(LTG)for upper gastric cancer has been demonstrated to be feasible,but the use of this assessment exclusively for Siewert type 2 adenocarcinoma of the esophagogastric junction(AEG)has not been reported.Methods:A total of 428 consecutive gastric-cancer patients who underwent LTG in Nanfang Hospital from January 2008 to December 2016 were reviewed.Among these patients,98 were classified as Siewert type 2 AEG.The patients underwent intracorporeal esophagojejunostomy through either a transorally inserted-anvil method(n=27)or extracorporeal anastomosis usinga circular stapler(n=71).After generating propensity scores with covariates that were associated with developing anastomotic leakage,26 patients who underwent esophagojejunostomy via the transorally inserted-anvil method(transoral group)were 1:1 matched with 26 patients who underwent the procedure via extracorporeal anastomosis using a circular stapler(extracorporeal group).The safety after 30 days post-operatively was compared between the two groups.Results:The transoral group and extracorporeal group were balanced regarding the baseline variables.The operative time,reconstruction duration,number of dissected lymph nodes,length of the proximal resectionmargins,estimated blood loss,intra-operative complication rate,and post-operative recovery course were not significantly different between the two groups.The mean anvil-insertion completion time(9.763.0 vs 13.462.0minutes,P<0.001)and the median incision length(5.5 vs 7.0 cm,P<0.001)in the transoral group were shorter than those in the extracorporeal group.The incidence of post-operative complications(26.9%vs 23.1%,P=0.749)and the classification of complication severity(P=0.939)were similar between the two groups.Conclusions:Intracorporeal esophagojejunostomy through a transorally inserted-anvil method may be a potentially safe approach to simplify and optimize the procedure during LTG for Siewer背景:对于近端胃癌全胃切除后消化道重建,采用经口置入砥钉座方法进行腔内食管空肠吻合已被证明是安全可行的。但尚未见到该方法用于Siewert 2型食管胃结合部腺癌(AEG)的评估报道。方法:2008年1月至2016年12月间,428例连续胃癌患者在广州南方医院接受腹腔镜全胃切除术,其中98例被归为Siewert 2型AEG。在98例AEG患者中,27例采用经口置入砥钉座方法进行腔内食管空肠吻合(经口组),71例采用圆形吻合器进行腔外食管空肠吻合(腔外组)。在基于吻合口漏危险因素进行1:1的倾向评分匹配后,26对匹配患者纳入分析。比较两组患者术后30天的安全性。结果:两组患者基线资料均衡。手术时间、消化道重建耗时、淋巴结清扫数量、近切缘长度、术中失血量、术中并发症发生率和术后恢复时间两组差异均无统计学意义。经口组相较腔外组,砥钉座置入时间更短(平均数:9.7 vs 13.4 min,P<0.001),手术切口更短(中位数:5.5 vs 7.0 cm,P<0.001)。术后并发症发生率两组差异无统计学意义(26.9%vs 23.1%,P¼0.749),并发症严重程度亦无显著差异(P¼0.939)。结论:采用经口置入砥钉座方法进行腔内食管空肠吻合,用以简化并优化Siewert 2型AEG患者全胃切除术后的消化道重建,是潜在安全的。

关 键 词：adenocarcinoma of the esophagogastric junction laparoscopic total gastrectomy ESOPHAGOJEJUNOSTOMY anastomotic leakage 

分 类 号：R735[医药卫生—肿瘤]