Modified jejunostomy in the application of thoracoscopic Ivor-Lewis esophageal surgery: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Pu , LIU Yongzhi , LI Genshui , CHEN Daqing , GUO Kunliang , WANG Huan , WANG Xiao ,  CHEN Jian

Department of Cardiothoracic Surgery, Anqing Municipal Hospital, Anqing, 246000, Anhui, P. R. China;

Corresponding?author：

CHEN Jian, Email: 423287497@qq.com

Keywords：

Esophageal cancer; thoracoscopic surgery; Ivor-Lewis; jejunostomy; complication

DOI：

10.7507/1007-4848.202406040

Video：

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Objective To evaluate the application effect of modified jejunostomy in thoracoscopic Ivor-Lewis esophagectomy. Methods A retrospective analysis of patients who underwent Ivor-Lewis esophagectomy for middle and lower esophageal cancer from 2017 to 2023 in Department of Cardiothoracic Surgery, Anqing Municipal Hospital was performed. The patients from 2017 to 2020 receiving "C+I" in the upper jejunum according to the "C+I" model, with fistula fixed with only two purse-string sutures and the abdominal wall were allocated into a group A. The patients from 2021 to 2023, on the basis of "C+I" suture, with the jejunum and abdominal wall fixed with 3-0 absorbable thread for 1-2 needles at the proximal or distal end of the fistula 10-15 mm, and the upper jejunum and abdominal wall fixed into "curtain" were allocated into a group B. The operation time, jejunostomy time, postoperative pathological stage, and enteral nutrition-related complications such as the incidence of incomplete intestinal obstruction, closed loop intestinal obstruction and intestinal volvulus requiring secondary surgery, skin redness and swelling of intestinal fluid leakage, stoma tube blockage, and accidental extubation were compared between the two groups. Results A total of 243 patients were enrolled in this study. The group A consisted of 118 patients (72 males, 46 females) with a mean age of (64.58±6.30) years. The group B consisted of 125 patients (76 males, 49 females) with a mean age of (65.11±6.81) years. All patients successfully underwent thoracoscopic Ivor-Lewis esophagectomy without perioperative mortality. There were no statistical differences between the two groups in operative time, jejunostomy creation time, or the rate of feeding tube occlusion (P>0.05). However, statistical differences were observed in the incidence of incomplete intestinal obstruction (P=0.035) and closed-loop intestinal obstruction requiring reoperation (P=0.017). The incidence of complications at the stoma site, such as intestinal fluid leakage and redness/swelling, was significantly higher in the group A (n=36) than that in the group B (n=7) (P<0.001). Conclusion The modified jejunostomy can significantly reduce the incomplete intestinal obstruction, closed loop intestinal obstruction and secondary operation rate after "C+I" jejunostomy, and significantly improve the leakage of intestinal fluid at the stoma and the injury of surrounding skin and soft tissue. Improvements in certain technologies reduce operational difficulties.

Citation： WANG Pu, LIU Yongzhi, LI Genshui, CHEN Daqing, GUO Kunliang, WANG Huan, WANG Xiao, CHEN Jian. Modified jejunostomy in the application of thoracoscopic Ivor-Lewis esophageal surgery: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(8): 1228-1233. doi: 10.7507/1007-4848.202406040 Copy

1.	張學鋒, 王鎮, 劉衛新, 等. 胸腹腔鏡輔助下Ivor-Lewis術式切除食管胃結合部癌的效果[J]. 中華腫瘤雜志, 2023, 45(4): 368-374.Zhang XF, Wang Z, Liu WX, et al. Thoracoscopic laparoscopy-assisted Ivor-Lewis resection of esophagogastric junction cancer[J]. Chin J Oncol, 2023, 45(4): 368-374.
2.	錢斌, 俞巍. 全腔鏡Ivor-Lewis術治療胸中下段食管癌的療效及對免疫功能的影響[J]. 現代腫瘤醫學, 2020, 28(14): 2426-2430.Qian B, Yu W. The clinical effect of total endoscopic Ivor Lewis surgery in the treatment of middle and lower thoracic esophageal cancer and its influence on immunologic function[J]. Mod Oncol, 2020, 28(14): 2426-2430.
3.	Casas MA, Angeramo CA, Bras Harriott C, et al. Surgical outcomes after totally minimally invasive Ivor Lewis esophagectomy[J]. A systematic review and meta-analysis. Eur J Surg Oncol, 2022, 48(3): 473-481.
4.	劉仲陽, 袁欣, 周文, 等. 微創小切口手術對早期胸中下段食管癌患者的治療效果及對其疼痛的[J]. 實用腫瘤學雜志, 2019, 33(1): 57-61.Liu ZY, Yuan X, Zhou W, et al. Therapeutic effect of minimally invasive small incision surgery on patients with early thoracic esophageal cancer and its in fluence in pain[J]. J Pract Oncol, 2019, 33(1): 57-61.
5.	Otake R, Okamura A, Kanamori J, et al. The optimal feeding enterostomy creation during esophagectomy to reduce the long-term risk of small bowel obstruction[J]. World J Surg, 2020, 44(11): 3845-3851.
6.	楊澤波, 張松林, 胡旭. 全腔鏡Ivor-Lewis手術治療中下段食管癌[J]. 巴楚醫學, 2023, 6(4): 32-34.Yang ZB, Zhang SL, Hu X. Total laparoscopic and thoracoscopic Ivor Lewis esophagectomy for middle-lower esophageal carcinoma[J]. Bachu Med J, 2023, 6(4): 32-34.
7.	Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer[J]. J Thorac Oncol, 2017, 12(1): 36-42.
8.	陳劍, 詹必成, 劉建, 等. 腔鏡聯合上腹部小切口與全腔鏡Ivor-Lewis食管切除術的近期臨床效果[J]. 中華胸心血管外科雜志, 2019, 35(4): 232-235.Chen J, Zhan BC, Liu J, et al. An observational comparison of totally endoscopic Ivor-lewis esophagectomy over assisted abdominal mini-incision[J]. Chin J Thorac Cardiovasc Surg, 2019, 35(4): 232-235.
9.	戎保林, 梅新宇, 吳顯寧. 腹腔鏡下空腸造瘺在微創食管癌Ivor-Lewis手術中的應用[J]. 中國臨床保健雜志, 2017, 20(2): 170-172.Rong BL, Mei XY, Wu XN. The application of laparoscopic jejunostomy during complete thoracoscopic and laparoscopic Ivor Lewis esophagectomy[J]. Chin J Clin Healthc, 2017, 20(2): 170-172.
10.	Kim SH. Safe and convenient intrathoracic anastomosis in minimally invasive Ivor Lewis esophagectomy[J]. J Minim Invasive Surg, 2023, 26(2): 53-54.
11.	Zhan B, Chen J, Du S, et al. Using the hand-sewn purse-string stapled anastomotic technique for minimally invasive Ivor Lewis esophagectomy[J]. Thorac Cardiovasc Surg, 2019, 67(7): 578-584.
12.	楊斌, 孫朋, 鄭鳳長, 等. 胸腹腔鏡食管癌根治術聯合胸內吻合術治療食管癌的臨床效果[J]. 中國現代藥物應用, 2023, 17(22): 57-60.Yang B, Sun P, Zheng FC, et al. Discussion on clinical effect of thoraco-laparoscopic esophagectomy combined with intrathoracic anastomosis in the treatment of esophageal cancer[J]. Chin J Mod Drug Appl, 2023, 17(22): 57-60.
13.	Jordan T, Mastnak DM, Palamar N, et al. Nutritional therapy for patients with esophageal cancer[J]. Nutr Cancer, 2018, 70(1): 23-29.
14.	林紅蘭, 任艷軍, 楊文超, 等. 早期腸內營養對食管癌根治術后患者預后影響的研究[J]. 中華保健醫學雜志, 2023, 25(6): 688-690.Lin HL, Ren YJ, Yang WC, et al. Research on the impact of early prognosis of postoperation enteral nutrition supportive therapy in patients with radical surgery for esophageal cencer[J]. Chin J Health Care Med, 2023, 25(6): 688-690.
15.	白向豆, 曾偉強, 崔百強, 等. 空腸造瘺管對比鼻空腸營養管在食管癌根治術后行腸內營養的療效與安全性的系統評價與Meta[J]. 中國胸心血管外科臨床雜志, 2023, 30(10): 1475-1482.Bai XD, Zeng WQ, Cui BQ, et al. Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: a systematic review and meta-analysis[J]. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(10): 1475-1482.
16.	Davies SJ, West MA, Rahman SA, et al. Oesophageal cancer: the effect of early nutrition support on clinical outcomes[J]. Clin Nutr ESPEN, 2021, 117-123.
17.	Baiu I, Spain DA. Enteral nutrition[J]. JAMA, 2019, 321(20): 2040.
18.	Tian J, Mei X, Guo M, et al. Effectiveness of jejunostomy for enteral nutrition during complete thoracoscopic and laparoscopic Ivor-Lewis esophagectomy in thoracic segment esophageal carcinoma[J]. J Cardiothorac Surg, 2020, 15(1): 142.
19.	Song HX, Wei SH, An GH, et al. Effect of sequential vs. non-sequential early enteral nutrition therapy on nutritional status, recovery, and quality of life of patients with esophageal cancer[J]. Eur Rev Med Pharmacol Sci, 2023, 27(16): 7590-7596.
20.	Janssen HJB, Gantxegi A, Fransen LFC, et al. Risk factors for failure of direct oral feeding following a totally minimally invasive esophagectomy[J]. Nutrients, 2021, 13(10): 3616.
21.	Koterazawa Y, Oshikiri T, Hasegawa H, et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition[J/OL]. Dis Esophagus, 2020, 33(1): doz021. DOI: 10.1093/dote/doz021.
22.	O'Regan PJ, Scarrow GD. Laparoscopic jejunostomy[J]. Endoscopy, 1990, 22(1): 39-40.
23.	Peng X, Zhu X, Wu Z, et al. Laparoscopic needle catheter jejunostomy by using a double semipurse string suture method in minimally invasive Ivor Lewis esophagectomy[J]. J Thorac Dis, 2020, 12(3): 240-248.
24.	岳彩迎, 宋偉安, 劉軍強, 等. 空腸穿刺造瘺術在食管癌外科治療中的應用: 258例分析[J]. 轉化醫學雜志, 2020, 9(6): 360-362.Yue CY, Song WA, Liu JQ, et al. The application of needle catheter jejunostomy for esophageal cancer: a study of 258 cases[J]. J Transl Med, 2020, 9(6): 360-362.
25.	林輝, 柳碩巖. 空腸造瘺術在食管癌手術中的臨床應用[J]. 醫學理論與實踐, 2017, 30(4): 525-527.Lin H, Liu SY. Clinical application of jejunostomy in esophageal cancer surgery[J]. J Med Theory Prac, 2017, 30(4): 525-527.
26.	Shiraishi O, Kato H, Iwama M, et al. A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the "curtain method"[J]. Surg Endosc, 2020, 34(11): 4967-4974.
27.	楊坡, 陳天鳴, 黃斌, 等. 改良復爾凱管空腸造瘺置管在胸腹腔鏡微創食管癌切除術中的應用[J]. 臨床腫瘤學雜志, 2022, 27(2): 143-147.Yang P, Chen TM, Huang B, et al. Application of modified flocare tube jejunostomy and catheterization in thoracoscopic and laparoscopic minimally invasive resection of esophageal cancer[J]. Chin Clin Oncol, 2022, 27(2): 143-147.

1. 張學鋒, 王鎮, 劉衛新, 等. 胸腹腔鏡輔助下Ivor-Lewis術式切除食管胃結合部癌的效果[J]. 中華腫瘤雜志, 2023, 45(4): 368-374.Zhang XF, Wang Z, Liu WX, et al. Thoracoscopic laparoscopy-assisted Ivor-Lewis resection of esophagogastric junction cancer[J]. Chin J Oncol, 2023, 45(4): 368-374.
2. 錢斌, 俞巍. 全腔鏡Ivor-Lewis術治療胸中下段食管癌的療效及對免疫功能的影響[J]. 現代腫瘤醫學, 2020, 28(14): 2426-2430.Qian B, Yu W. The clinical effect of total endoscopic Ivor Lewis surgery in the treatment of middle and lower thoracic esophageal cancer and its influence on immunologic function[J]. Mod Oncol, 2020, 28(14): 2426-2430.
3. Casas MA, Angeramo CA, Bras Harriott C, et al. Surgical outcomes after totally minimally invasive Ivor Lewis esophagectomy[J]. A systematic review and meta-analysis. Eur J Surg Oncol, 2022, 48(3): 473-481.
4. 劉仲陽, 袁欣, 周文, 等. 微創小切口手術對早期胸中下段食管癌患者的治療效果及對其疼痛的[J]. 實用腫瘤學雜志, 2019, 33(1): 57-61.Liu ZY, Yuan X, Zhou W, et al. Therapeutic effect of minimally invasive small incision surgery on patients with early thoracic esophageal cancer and its in fluence in pain[J]. J Pract Oncol, 2019, 33(1): 57-61.
5. Otake R, Okamura A, Kanamori J, et al. The optimal feeding enterostomy creation during esophagectomy to reduce the long-term risk of small bowel obstruction[J]. World J Surg, 2020, 44(11): 3845-3851.
6. 楊澤波, 張松林, 胡旭. 全腔鏡Ivor-Lewis手術治療中下段食管癌[J]. 巴楚醫學, 2023, 6(4): 32-34.Yang ZB, Zhang SL, Hu X. Total laparoscopic and thoracoscopic Ivor Lewis esophagectomy for middle-lower esophageal carcinoma[J]. Bachu Med J, 2023, 6(4): 32-34.
7. Rice TW, Ishwaran H, Ferguson MK, et al. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer[J]. J Thorac Oncol, 2017, 12(1): 36-42.
8. 陳劍, 詹必成, 劉建, 等. 腔鏡聯合上腹部小切口與全腔鏡Ivor-Lewis食管切除術的近期臨床效果[J]. 中華胸心血管外科雜志, 2019, 35(4): 232-235.Chen J, Zhan BC, Liu J, et al. An observational comparison of totally endoscopic Ivor-lewis esophagectomy over assisted abdominal mini-incision[J]. Chin J Thorac Cardiovasc Surg, 2019, 35(4): 232-235.
9. 戎保林, 梅新宇, 吳顯寧. 腹腔鏡下空腸造瘺在微創食管癌Ivor-Lewis手術中的應用[J]. 中國臨床保健雜志, 2017, 20(2): 170-172.Rong BL, Mei XY, Wu XN. The application of laparoscopic jejunostomy during complete thoracoscopic and laparoscopic Ivor Lewis esophagectomy[J]. Chin J Clin Healthc, 2017, 20(2): 170-172.
10. Kim SH. Safe and convenient intrathoracic anastomosis in minimally invasive Ivor Lewis esophagectomy[J]. J Minim Invasive Surg, 2023, 26(2): 53-54.
11. Zhan B, Chen J, Du S, et al. Using the hand-sewn purse-string stapled anastomotic technique for minimally invasive Ivor Lewis esophagectomy[J]. Thorac Cardiovasc Surg, 2019, 67(7): 578-584.
12. 楊斌, 孫朋, 鄭鳳長, 等. 胸腹腔鏡食管癌根治術聯合胸內吻合術治療食管癌的臨床效果[J]. 中國現代藥物應用, 2023, 17(22): 57-60.Yang B, Sun P, Zheng FC, et al. Discussion on clinical effect of thoraco-laparoscopic esophagectomy combined with intrathoracic anastomosis in the treatment of esophageal cancer[J]. Chin J Mod Drug Appl, 2023, 17(22): 57-60.
13. Jordan T, Mastnak DM, Palamar N, et al. Nutritional therapy for patients with esophageal cancer[J]. Nutr Cancer, 2018, 70(1): 23-29.
14. 林紅蘭, 任艷軍, 楊文超, 等. 早期腸內營養對食管癌根治術后患者預后影響的研究[J]. 中華保健醫學雜志, 2023, 25(6): 688-690.Lin HL, Ren YJ, Yang WC, et al. Research on the impact of early prognosis of postoperation enteral nutrition supportive therapy in patients with radical surgery for esophageal cencer[J]. Chin J Health Care Med, 2023, 25(6): 688-690.
15. 白向豆, 曾偉強, 崔百強, 等. 空腸造瘺管對比鼻空腸營養管在食管癌根治術后行腸內營養的療效與安全性的系統評價與Meta[J]. 中國胸心血管外科臨床雜志, 2023, 30(10): 1475-1482.Bai XD, Zeng WQ, Cui BQ, et al. Efficacy and safety of enteral nutrition with jejunostomy tube versus nasojejunal tube after radical resection of esophageal cancer: a systematic review and meta-analysis[J]. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(10): 1475-1482.
16. Davies SJ, West MA, Rahman SA, et al. Oesophageal cancer: the effect of early nutrition support on clinical outcomes[J]. Clin Nutr ESPEN, 2021, 117-123.
17. Baiu I, Spain DA. Enteral nutrition[J]. JAMA, 2019, 321(20): 2040.
18. Tian J, Mei X, Guo M, et al. Effectiveness of jejunostomy for enteral nutrition during complete thoracoscopic and laparoscopic Ivor-Lewis esophagectomy in thoracic segment esophageal carcinoma[J]. J Cardiothorac Surg, 2020, 15(1): 142.
19. Song HX, Wei SH, An GH, et al. Effect of sequential vs. non-sequential early enteral nutrition therapy on nutritional status, recovery, and quality of life of patients with esophageal cancer[J]. Eur Rev Med Pharmacol Sci, 2023, 27(16): 7590-7596.
20. Janssen HJB, Gantxegi A, Fransen LFC, et al. Risk factors for failure of direct oral feeding following a totally minimally invasive esophagectomy[J]. Nutrients, 2021, 13(10): 3616.
21. Koterazawa Y, Oshikiri T, Hasegawa H, et al. Routine placement of feeding jejunostomy tube during esophagectomy increases postoperative complications and does not improve postoperative malnutrition[J/OL]. Dis Esophagus, 2020, 33(1): doz021. DOI: 10.1093/dote/doz021.
22. O'Regan PJ, Scarrow GD. Laparoscopic jejunostomy[J]. Endoscopy, 1990, 22(1): 39-40.
23. Peng X, Zhu X, Wu Z, et al. Laparoscopic needle catheter jejunostomy by using a double semipurse string suture method in minimally invasive Ivor Lewis esophagectomy[J]. J Thorac Dis, 2020, 12(3): 240-248.
24. 岳彩迎, 宋偉安, 劉軍強, 等. 空腸穿刺造瘺術在食管癌外科治療中的應用: 258例分析[J]. 轉化醫學雜志, 2020, 9(6): 360-362.Yue CY, Song WA, Liu JQ, et al. The application of needle catheter jejunostomy for esophageal cancer: a study of 258 cases[J]. J Transl Med, 2020, 9(6): 360-362.
25. 林輝, 柳碩巖. 空腸造瘺術在食管癌手術中的臨床應用[J]. 醫學理論與實踐, 2017, 30(4): 525-527.Lin H, Liu SY. Clinical application of jejunostomy in esophageal cancer surgery[J]. J Med Theory Prac, 2017, 30(4): 525-527.
26. Shiraishi O, Kato H, Iwama M, et al. A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the "curtain method"[J]. Surg Endosc, 2020, 34(11): 4967-4974.
27. 楊坡, 陳天鳴, 黃斌, 等. 改良復爾凱管空腸造瘺置管在胸腹腔鏡微創食管癌切除術中的應用[J]. 臨床腫瘤學雜志, 2022, 27(2): 143-147.Yang P, Chen TM, Huang B, et al. Application of modified flocare tube jejunostomy and catheterization in thoracoscopic and laparoscopic minimally invasive resection of esophageal cancer[J]. Chin Clin Oncol, 2022, 27(2): 143-147.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified jejunostomy in the application of thoracoscopic Ivor-Lewis esophageal surgery: A retrospective cohort study

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