Comparison of the Influence of Intrathoracic and Retrosternal Esophagogastric Anastomosis on Pulmonary Function in Aged Patients after Esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHOUZhi-ming , WANGZe-xue , LIUYong-xin , LIANGLei

Department of Thoracic Surgery, Fengtian Hospital, Shenyang Medical College, Shenyang 110024, P. R. China;

Corresponding author：

ZHOUZhi-ming, Email: ftyyxwk@163.com

Keywords：

Aged; Esophageal carcinoma; Intrathoracic esophagogastric anastomosis; Retrosternal esophago-gastric anastomosis; Pulmonary function

DOI：

10.7507/1007-4848.20140139

Video：

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Objective To compare the influence of intrathoracic and retrosternal esophagogastric anastomosis on pulmonary function in aged patients after esophagectomy. Methods Forty patients (older than 62 years) with upper or middle thoracic esophageal carcinoma (EC) who underwent esophagectomy in Fengtian Hospital of Shenyang Medical College between February 2009 and May 2011 were enrolled in this study. According to different surgical approach, all the patients were divided into an intrathoracic esophagogastric anastomosis (IEGA) group and a retrosternal esophagogastric anastomosis (REGA) group. There were 20 patients in IEGA group including 16 males and 4 females with their age of 62-79 (64.70±11.47) years, who received cervical anastomosis after EC resection and intrathoracic gastric tube reconstruction. There were 20 patients in REGA group including 17 males and 3 females with their age of 63-77 (65.90±12.72) years, who received cervical anastomosis after EC resection and retrosternal gastric tube reconstruction. Pulmonary function test (PFT) was performed preoperatively and on the 15th and 30th postoperative day, and compared between the 2 groups. Results There was no statistical difference in preoperative PFT between the 2 groups (P > 0.05). PFT of IEGA group on the 15th and 30th postoperative day was significantly worse than preoperative PFT (P < 0.05). PFT of REGA group on the 15th and 30th postoperative day was not statistically different from preoperative PFT (P > 0.05). PFT of REGA group on the 15th and 30th postoperative day was significantly better than PFT of IEGA group (P < 0.05). In IEGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, pneumonia in 5 patients and atelectasis in 1 patient. In REGA group, postoperative complications included anastomotic leak in 1 patient, anastomotic stenosis in 1 patient, gastric outlet obstruction in 1 patient and pneumonia in 3 patients. All the patients were followed up for 1 year. There was no statistical difference between PFT at 1 year after discharge and PFT on the 30th postoperative day in either group. Conclusions IEGA can significantly reduce postoperative PFT. REGA has less negative influence on postoperative PFT, is suitable for aged patients and patients with unsatisfactory preoperative PFT, can reduce postoperative complications and improve postoperative quality of life.

Citation： ZHOUZhi-ming, WANGZe-xue, LIUYong-xin, LIANGLei. Comparison of the Influence of Intrathoracic and Retrosternal Esophagogastric Anastomosis on Pulmonary Function in Aged Patients after Esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 490-493. doi: 10.7507/1007-4848.20140139 Copy

1.	齐战, 朱德成, 陈万生, 等.胸骨后胃对食管癌围手术期呼吸功能的影响.中华胸心血管外科杂志, 2000, 16 (3):26-28.
2.	黄建家, 付俊慧, 王卫光, 等.管状胃代食管对食管癌术后肺功能的影响.临床和实验医学杂志, 2008, 10 (7):29-30.
3.	Berkow R, 主编.默克诊疗手册.第15版.北京:人民卫生出版社, 1992. 587.
4.	Jiao WJ, Wang TY, Gong M, et al. Pulmonary complications in patients with chronic obstructive pulmonary disease following trans-thoracic esophagectomy. World J Gastroenterol, 2006, 12 (16):2505-2509.
5.	郭伟, 蒋耀光, 王知文, 等.不同术式食管癌根治术前后患者肺功能情况研究.局解手术学杂志, 2009, 18 (2):96-98.
6.	冯晓祥, 王群, 蒋伟, 等.食管切除术后管状胃不同上提路径的比较.中华胃肠外科杂志, 2010, 13 (1):33-35.
7.	Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up:the effect of the route of reconstruction. World J Surg, 2005, 29 (2):174-181.
8.	Kato H, Miyazaki T, Sakai M, et al. Videofluoroscopic evaluation in oropharyngeal swallowing after radical esophagectomy with lympha-denectomy for esophageal cancer. Anticancer Res, 2007, 27 (6C):4249-4254.
9.	毛友生, 张汝刚, 孙莉, 等.食管癌病人术前肺功能与全麻开胸状态下气道阻力相关性的研究.中华胸心血管外科杂志, 1999, 15 (4):222-224.
10.	李勇, 施巩宁, 马红冰, 等.管状胃对食管癌术后围术期呼吸功能的影响.临床医学, 2010, 30 (5):61-62.
11.	冯刚, 甘崇志, 丛伟, 等.两种弓上吻合途径对食管胸中段癌患者术后肺功能的影响.华西医学, 2003, 18 (1):12-13.
12.	郭海周, 王建军, 周福有, 等.管状胃对食管癌切除术后并发症的改善作用.中华胃肠外科杂志, 2010, 14 (1):65-66.
13.	刘颖珍, 肖庆隆, 徐波, 等.胸部肿瘤病人围手术期血气监测及临床意义.中华胸心血管外科杂志, 1994, 10 (3):220-222.
14.	武新慧, 张玉想, 胡震杰, 等.食管癌术后严重并发症临床分析及对策.河北医科大学学报, 2008, 29 (5):668-671.
15.	伍传新, 陈树群, 林昱, 等.管状胃经食管床弓上吻合术对食管癌术后肺功能的影响.中华胃肠外科杂志, 2010, 13 (6):450-451.
16.	陈万生, 刘艳慧, 南茹, 等.食管癌术后的呼吸功能.中华胸心血管外科杂志, 2007, 23 (5):317-319.
17.	何丹, 韩峰, 张国庆, 等.管状胸腔胃对食管癌根治术后患者生活质量的影响.中华胃肠外科杂志, 2011, 14 (9):728-729.
18.	Maruyamrk, Kitymura M, Izumi K, et al. Postoperative lung volume calculated by chest computed tompgraphy in patients with esophageal cancer. Jpn Thorac Cardiovasc Surg, 1999, 47 (5):193-198.
19.	Morita M, Egashira A, Yoshida R, et al. Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus. J Gastroenterol, 1999, 43 (5):345-351.
20.	车嘉铭, 项捷, 陈凯, 等.管状胃在食管、贲门癌手术中的临床应用.中国胸心血管外科临床杂志, 2010, 17 (2):96-98.

1. 齐战, 朱德成, 陈万生, 等.胸骨后胃对食管癌围手术期呼吸功能的影响.中华胸心血管外科杂志, 2000, 16 (3):26-28.
2. 黄建家, 付俊慧, 王卫光, 等.管状胃代食管对食管癌术后肺功能的影响.临床和实验医学杂志, 2008, 10 (7):29-30.
3. Berkow R, 主编.默克诊疗手册.第15版.北京:人民卫生出版社, 1992. 587.
4. Jiao WJ, Wang TY, Gong M, et al. Pulmonary complications in patients with chronic obstructive pulmonary disease following trans-thoracic esophagectomy. World J Gastroenterol, 2006, 12 (16):2505-2509.
5. 郭伟, 蒋耀光, 王知文, 等.不同术式食管癌根治术前后患者肺功能情况研究.局解手术学杂志, 2009, 18 (2):96-98.
6. 冯晓祥, 王群, 蒋伟, 等.食管切除术后管状胃不同上提路径的比较.中华胃肠外科杂志, 2010, 13 (1):33-35.
7. Katsoulis IE, Robotis I, Kouraklis G, et al. Duodenogastric reflux after esophagectomy and gastric pull-up:the effect of the route of reconstruction. World J Surg, 2005, 29 (2):174-181.
8. Kato H, Miyazaki T, Sakai M, et al. Videofluoroscopic evaluation in oropharyngeal swallowing after radical esophagectomy with lympha-denectomy for esophageal cancer. Anticancer Res, 2007, 27 (6C):4249-4254.
9. 毛友生, 张汝刚, 孙莉, 等.食管癌病人术前肺功能与全麻开胸状态下气道阻力相关性的研究.中华胸心血管外科杂志, 1999, 15 (4):222-224.
10. 李勇, 施巩宁, 马红冰, 等.管状胃对食管癌术后围术期呼吸功能的影响.临床医学, 2010, 30 (5):61-62.
11. 冯刚, 甘崇志, 丛伟, 等.两种弓上吻合途径对食管胸中段癌患者术后肺功能的影响.华西医学, 2003, 18 (1):12-13.
12. 郭海周, 王建军, 周福有, 等.管状胃对食管癌切除术后并发症的改善作用.中华胃肠外科杂志, 2010, 14 (1):65-66.
13. 刘颖珍, 肖庆隆, 徐波, 等.胸部肿瘤病人围手术期血气监测及临床意义.中华胸心血管外科杂志, 1994, 10 (3):220-222.
14. 武新慧, 张玉想, 胡震杰, 等.食管癌术后严重并发症临床分析及对策.河北医科大学学报, 2008, 29 (5):668-671.
15. 伍传新, 陈树群, 林昱, 等.管状胃经食管床弓上吻合术对食管癌术后肺功能的影响.中华胃肠外科杂志, 2010, 13 (6):450-451.
16. 陈万生, 刘艳慧, 南茹, 等.食管癌术后的呼吸功能.中华胸心血管外科杂志, 2007, 23 (5):317-319.
17. 何丹, 韩峰, 张国庆, 等.管状胸腔胃对食管癌根治术后患者生活质量的影响.中华胃肠外科杂志, 2011, 14 (9):728-729.
18. Maruyamrk, Kitymura M, Izumi K, et al. Postoperative lung volume calculated by chest computed tompgraphy in patients with esophageal cancer. Jpn Thorac Cardiovasc Surg, 1999, 47 (5):193-198.
19. Morita M, Egashira A, Yoshida R, et al. Esophagectomy in patients 80 years of age and older with carcinoma of the thoracic esophagus. J Gastroenterol, 1999, 43 (5):345-351.
20. 车嘉铭, 项捷, 陈凯, 等.管状胃在食管、贲门癌手术中的临床应用.中国胸心血管外科临床杂志, 2010, 17 (2):96-98.

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Comparison of the Influence of Intrathoracic and Retrosternal Esophagogastric Anastomosis on Pulmonary Function in Aged Patients after Esophagectomy

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