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 assessm...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展开更多
BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantag...BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.展开更多
Objective:To identify risk factors for anastomotic leakage after gastrectomy in patients with Siewert type II/III adenocarcinoma(AEG)of the esophagogastric junction.Methods:This was a retrospective case-control study ...Objective:To identify risk factors for anastomotic leakage after gastrectomy in patients with Siewert type II/III adenocarcinoma(AEG)of the esophagogastric junction.Methods:This was a retrospective case-control study of 903 patients with Siewert type II/III AEG treated from January 2012 to January 2015 at the Shanxi Cancer Hospital in China.All patients underwent gastrectomy,and their clinical characteristics were analyzed to identify associations with anastomotic leakage.Independent risk factors were identified by binary logistic regression.The 2-year disease-free survival was calculated and compared between patients with anastomotic leakage and control patients.The study was approved by the Institutional Review Board of Shanxi Medical University(approval No.2014-09-39)on September 19,2014.Results:Out of the 903 patients were included in the study,80(8.86%,80/903)experienced anastomotic leakage.The mortality rate attributed to anastomotic leakage was 8.75%(7/80).Logistic regression analysis revealed that preoperative hypoalbuminemia(odds ratio(OR)=3.249,95%confidence interval(CI):1.569-6.725,P=0.002),type of reconstruction(OR=1.795,95%CI:1.026-3.142,P=0.040),and combined organ resection(OR=1.807,95%CI:1.069-3.055,P=0.027)were independent risk factors for anastomotic leakage.Conclusion:Preoperative hypoalbuminemia,type of reconstruction,and combined organ resection were identified as risk factors for anastomotic leakage in patients undergoing gastrectomy for Siewert type Ⅱ/Ⅲ AEG.展开更多
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].
文摘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
文摘BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.
基金the Wu Jieping Medical Foundation(Nos.320.6750.2020-11-5 and 320.6750.2020-11-6)Key Research and Development(R&D)Projects of Shanxi Province(No.201703D321008).
文摘Objective:To identify risk factors for anastomotic leakage after gastrectomy in patients with Siewert type II/III adenocarcinoma(AEG)of the esophagogastric junction.Methods:This was a retrospective case-control study of 903 patients with Siewert type II/III AEG treated from January 2012 to January 2015 at the Shanxi Cancer Hospital in China.All patients underwent gastrectomy,and their clinical characteristics were analyzed to identify associations with anastomotic leakage.Independent risk factors were identified by binary logistic regression.The 2-year disease-free survival was calculated and compared between patients with anastomotic leakage and control patients.The study was approved by the Institutional Review Board of Shanxi Medical University(approval No.2014-09-39)on September 19,2014.Results:Out of the 903 patients were included in the study,80(8.86%,80/903)experienced anastomotic leakage.The mortality rate attributed to anastomotic leakage was 8.75%(7/80).Logistic regression analysis revealed that preoperative hypoalbuminemia(odds ratio(OR)=3.249,95%confidence interval(CI):1.569-6.725,P=0.002),type of reconstruction(OR=1.795,95%CI:1.026-3.142,P=0.040),and combined organ resection(OR=1.807,95%CI:1.069-3.055,P=0.027)were independent risk factors for anastomotic leakage.Conclusion:Preoperative hypoalbuminemia,type of reconstruction,and combined organ resection were identified as risk factors for anastomotic leakage in patients undergoing gastrectomy for Siewert type Ⅱ/Ⅲ AEG.
