Despite a wider application of robot to radical esophageal resection in recent years, the process of esophagogastrostomy is relatively complicated. Current commonly-applied clinical techniques in digestive tract reconstruction include end-to-end anastomosis, end-to-side anastomosis, and side-side anastomosis. The main methods are divided into manual and mechanical anastomosis. And the main instruments applied include circular stapler and linear stapler. Different technologies vary in advantages and restrictions and selecting the technique in esophageal operation depends on the situation of the tumor and the operator’s preference. The improved anastomosis techniques and the updated anastomosis instruments effectively lower the incidence of complications after esophagogastrostomy. However, there are still great difficulties in carrying out a safe and efficient reconstruction of the digestive tract during the operation. Scholars over the world have been working hard on it and have made modified various reconstruction techniques. Different technologies vary in advantages and restrictions and the choice of the technique depends on the situation of the tumor and the patient’s preference. There is no unified consensus on the choice of the technique. This paper introduces the research progress in robot’s assisted esophagogastrostomy from two aspects including the technique and method of anastomosis.
Objective To analyze the influencing factors for postoperative anastomotic leak (AL) in carcinoma of the esophagus and gastroesophageal junction and construct a nomogram predictive model. Methods The patients who underwent radical esophagectomy at Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were selected. After screening related variables using univariate and multivariate logistic regression analyses, the nomogram was used to predict the risk factors for postoperative AL. The predicted effects were verified by the receiver operating characteristic (ROC) curve. Results A total of 468 patients with carcinoma of the esophagus and gastroesophageal junction were collected, including 354 males and 114 females with a mean age of (62.8±7.2) years. The tumor was mainly located in the middle or lower stage; 51 (10.90%) patients had postoperative AL. In univariate logistic regression analysis, age, body mass index (BMI), tumor location, preoperative albumin, diabetes mellitus, anastomosis mode, anastomosis site, and C-reactive protein (CRP) level might be associated with anAL (P＜0.05). The results of multivariate logistic regression analysis illustrated that age, BMI, tumor location, diabetes mellitus, anastomosis mode, and CRP level were independent risk factors for AL (P＜0.05). The nomogram was constructed according to the results of multivariate logistic regression analysis. The area under the curve (AUC) of ROC curve was 0.803 showing that the actual observations agreed well with the predicted results. In addition, the decision curve analysis showed that the newly established nomogram was significant for clinical decision-making. Conclusion The predictive model of postoperative AL in carcinoma of the esophagus and gastroesophageal junction has a good predictive effect and is critical for guiding clinical observation, early screening and prevention.