Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction
Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction
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DOI：
10.1007/s00423-021-02377-5
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发表时间：
2021-11-13
影响因子：
2.3
通讯作者：
Kanaya, Seiichiro
中科院分区：
文献类型：
--
作者：
Hosogi, Hisahiro;Sakaguchi, Masazumi;Kanaya, Seiichiro
目的 腹腔镜近端胃切除术联合下段食管切除术（扩展 LPG）和微创 Ivor Lewis 食管切除术 (MIILE) 都是食管胃结合部腺癌 (AEG) 可接受的治疗方法，但纵隔食管胃造口术的最佳重建技术（提供充分预防反流的技术）尚未建立。我们设计了一种新颖的侧重叠食管胃管（SO-EG）重建。方法 我们对 LPG 或 MIILE 后的患者记录进行了回顾性审查。我们为每位患者制作了一根 3 厘米宽的胃管，与食道重叠 5 厘米。将线性吻合器沿大弯插入食管残端左侧和胃前壁。关闭入口孔，进行狭缝状吻合，将食管壁右侧固定于胃前壁。结果 2020 年 6 月至 2021 年 7 月期间，连续 10 名患者接受了该手术。其中 5 名患者患有 Siewert II 型 AEG：4 名患有下胸段食管癌，1 名患有良性下食管狭窄。共有 3 名患者接受了延长 LPG 治疗，7 名患者接受了 MIILE。中位手术时间为 352 分钟（范围：221-556 分钟）。 9 名患者术后过程平稳；一名患者出现肺炎。 7 名患者在 6 个月时接受了随访内窥镜检查。吻合口狭窄1例，轻度反流性食管炎2例，行保守治疗。结论 我们的新型SO-EG重建方法简单可行，对于预防反流性食管炎具有可接受的效果。该技术可以使用扩展 LPG 或 MIILE 来执行。
Purpose Both laparoscopic proximal gastrectomy with lower esophagectomy (extended LPG) and minimally invasive Ivor Lewis esophagectomy (MIILE) are acceptable treatments for adenocarcinoma of the esophagogastric junction (AEG), but the optimal reconstruction technique for mediastinal esophagogastrostomy (one that provides adequate reflux prevention) has not been established. We devised a novel side-overlap esophagogastric-tube (SO-EG) reconstruction. Methods We performed a retrospective review of patient records after LPG or MIILE. In each patient, we created a 3-cm wide gastric tube, overlapping the esophagus by 5 cm. A linear stapler was inserted into the left side of the esophageal stump and the anterior gastric wall along the greater curvature. The entry hole was closed to make a slit-like anastomosis, and the right side of the esophageal wall was fixed to the anterior gastric wall. Results Ten consecutive patients underwent this procedure between June 2020 and July 2021. Five patients had Siewert type II AEG: 4 with lower thoracic esophageal cancer and 1 with benign lower esophageal stenosis. A total of 3 patients underwent extended LPG, and 7 underwent MIILE. The median operative time was 352 min (range, 221-556 min). The postoperative course was uneventful in 9 patients; a single patient developed pneumonia. Seven patients underwent follow-up endoscopy at 6 months. One patient with anastomotic stenosis and 2 with mild reflux esophagitis were treated conservatively. Conclusion Our novel SO-EG reconstruction is simple and feasible, with acceptable results for preventing reflux esophagitis. This technique can be performed with either extended LPG or MIILE.