Application of end-to-end double-layer hand-sewn esophagogastric anastomosis and gastric fundus embedding during minimally invasive esophagectomy for esophageal cancer

Abstract

Background and purpose: There are many anastomoses between stomach and esophagus in esophageal cancer surgery, each of which has its own advantages and disadvantages. The aim of this study was to investigate the safety and feasibility of end-to-end double-layer esophagogastric anastomosis and gastric fundus embedding during minimally invasive esophagectomy for esophageal cancer. Methods: The clinicopathological data of 129 patients who underwent minimally invasive esophagectomy from April 2019 to April 2021 in Zigong Fourth People’s Hospital were retrospectively reviewed. All patients were treated with thoracoscopy and laparoscopy combined with minimally invasive cervicothoracic and abdominal tri-incision (McKeown procedure) esophageal cancer resection. The thoracic procedure was performed with thoracoscopy, and the abdominal procedure with laparoscopy. The patients were divided into end-to-end double-layer esophagogastric anastomosis and gastric fundus embedding group (87 cases) and end-to-side anastomosis group (42 cases). Patients were followed up for evaluation of associated complications, of which anastomotic leakage, anastomotic stenosis and gastroesophageal reflux were the primary objectives of this study. Results: All the 129 patients underwent esophagectomy. Neoadjuvant therapy was more common in the end-to-end doubled anastomosis group (12.0% vs 2.3%, P = 0.037). There was no statistically significant difference in other basic clinical data between the two groups (P>0.05). There was no significant difference in the mean operation time between the two groups. The anastomosis time was less in end-to-side stapling group than in end-to-end stapling group[(32.0±6.8) min vs (15.0±5.4) min, P = 0.021]. The differences in the incidences of anastomotic leakage (1.1% vs 11.9%, P = 0.023), gastroesophageal reflux (9.1% vs 26.1%, P = 0.012), pneumonia (12.6% vs 30.9%, P = 0.023) and arrhythmia (10.3% vs 26.1.%, P = 0.020) were statistically significant between the two groups. Conclusion: The method of end-to-end double-layer anastomosis and gastric fundus embedding is safe and stable in esophagectomy. It can effectively prevent anastomotic leakage and gastroesophageal reflux.

Keywords

• |esophageal cancer|esophagectomy|hand-sewn anastomosis|end-to-end clouble-layer esophagogastric anastomosis|gastric fundus embedding