An integrated strategy for reducing anastomotic leakage in patients undergoing McKeown esophagectomy
Yan Zhang,
Junya Wang,
Shuang Ren,
Jia Jiao,
Zheng Ding,
Hang Yang,
Dabo Pan,
Jindong Li,
Guoqing Zhang,
Xiangnan Li,
Song Zhao
Affiliations
Yan Zhang
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Junya Wang
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Shuang Ren
Department of Oncology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Jia Jiao
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Zheng Ding
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Hang Yang
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Dabo Pan
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Jindong Li
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
Guoqing Zhang
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China; Corresponding author. Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan Province, China.
Xiangnan Li
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China; Corresponding author. Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou 450052, Henan Province, China. (Tel: +86-371-66271812; Fax: +86-371-66271812)
Song Zhao
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China; Corresponding author. Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, 450052, Henan Province, China.
Objective: To describe our experience of reducing anastomotic leakage, a problem that has not been properly solved. Methods: Starting in January 2020, we began implementing our integrated strategy (application of an esophageal diameter-approximated slender gastric tube, preservation of the fibrous tissue around the residual esophagus and thyroid inferior pole anastomosis) in consecutive patients undergoing esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube. Additionally, the blood supply at the site of the anastomosis was evaluated with a near-infrared fluorescence thoracoscope after the completion of esophagogastric anastomosis in the integrated strategy group. Results: Of 570 patients who were reviewed, 119 (20.9%) underwent the integrated strategy, and 451 (79.1%) underwent the conventional strategy. The rate of anastomotic leakage was 2.5% in the integrated strategy group and 10.2% in the conventional strategy group (p = 0.008). In the integrated strategy group, the site of most of the anastomotic blood supply was the residual esophagus dominant (82.4%), followed by the gastroesophageal dual-dominant (12.6%) and the gastric tube dominant (5.0%). The reconstruction route was more likely to be orthotopic in the integrated strategy group than in the conventional strategy group (89.9% vs. 38.6%, p = 0.004). Gastric dilation was identified in 3.4% of the patients in the integrated strategy group and in 21.1% in the conventional strategy group. Conclusions: Patients who underwent our proposed integrated strategy (Zhengzhou Strategy) during McKeown esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube had a strikingly lower rate of anastomotic leakage and a relatively lower rate of postoperative complications, such as gastric tube dilation and delayed gastric emptying.
