The risk factors of esophagogastric anastomotic leak in the perioperative period include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, vasopressor drugs use, intravenous fluid administration, blood transfusion and surgical anastomotic technique, which can be reduced with the improvement of surgeons' ability to identify the high-risk patients. This article summarizes the specific measures for these risk factors: preoperative nutritional support for 5–7 d for malnourished patients, full intestinal preparation, perioperative smoking cessation, limitation of steroids and vasopressors drug applications, avoidance of early operations (<4 weeks) following chemotherapy, and the goal-directed fluid management.
ObjectiveTo compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. MethodsMedline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. ResultsA total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. ConclusionMechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.
Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.
ObjectiveTo investigate the feasibility of thoracolapascopic esophagectomy (TLE) without routine nasogastric (NG) intubation for patients with esophageal cancer (EC). MethodsClinical data of 78 EC patients under-going TLE without perioperative NG intubation in Affiliated Cancer Hospital of Zhengzhou University from January to September 2013 were analyzed (non-NG intubation group, including 48 male and 30 female patients with their age of 61.1± 8.5 years). Seventy-eight EC patients undergoing TLE with routine NG intubation for 7 days in 2012 were chosen as the control group (NG intubation group, including 50 male and 28 female patients with their age of 60.3±7.0 years). Operation time, postoperative morbidity, gastrointestinal functional recovery and patient discomfort were compared between the 2 groups. ResultsThere was no in-hospital death in either groups. There was no statistic difference in the incidences of pulmonary infection (16.7% vs. 19.2%, P=0.676), anastomotic leakage (1.3% vs. 2.6%, P=0.560) or NG tube replacement (3.8% vs. 2.6%, P=0.649) between non-NG intubation group and NG intubation group. Time for recovery of intestinal motility (2.5± 1.1 days vs. 4.3±1.2 days, P < 0.05) and time for air evacuation (3.6±1.7 days vs. 5.8±2.1 days, P < 0.05) of non-NG intubation group were significantly shorter than those of NG intubation group. Ninety-seven percent of the patients (76/78)in NG intubation group had uncomfortable feeling including dry mouth and sore throat, and only 6% of the patients (5/78) in non-NG intubation group had nausea. All the patients were followed up for 3 months after discharge. There was no intestinal obstruction, pneumonia or late anastomotic leakage during follow-up. ConclusionTLE without routine NG intubation is safe and feasible for EC patients, which can not only reduce patients' discomfort but also improve early recovery of gastrointestinal function.
Objective To explore an effective and minimal invasive drainage procedure for intrathoracic anastomotic leakage after esophagectomy. Method A total of 14 patients (10 males and 4 females, aged 48 to 70 years) with encapsulated effusion due to thoracic anastomotic leakage after esophagectomy were performed accurate thoracic drainage which was guided by ultrasonography in Renji Hospital from January 2012 through December 2014. The J shape flexible catheter was placed into the effusion cavity near the leakage. Gasric drainage and enteral nutrition support were conducted as well. Result All the patients with leakage healed smoothly. The hospital stay was 27 to 94 days. Time of drainage was 17 to 89 days. The drainage volume was 5-260 ml per day. No complication related to drainage occurred. Conclusion Placing the J shape flexible catheter for plural drainage guided by ultrasonography or chest CT scan is a desirable and less injured therapy for intrathoracic leakage after esophagectomy.
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy. Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012), EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, Plt;0.01). Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.
Objective To assess the effectiveness of large-calibre (7.5#) transanal tube drainage and decompression on prevention from anastomotic leakage following anterior resection for rectal cancer. Methods Clinical data of 346 consecutive patients (M/F=1.39, age range 32-84 years, median age 58.5 years) undergone anterior resection for rectal cancer in this institute from January 2006 to December 2008 were analyzed retrospectively. Results The anastomotic leakage rate was 0 (0/185) and 5.59%(9/161) in patients with or without receiving large-calibre transanal tube drainage respectively. The anastomotic leakage rate was significantly decreased by large-calibre transanal tube drainage after anterior resection for rectal cancer (χ2=8.526, P=0.004). Eight cases of anastomotic leakage were treated conservatively and the other one required further surgical interventions. No perioperative death occurred in this series. Conclusion In this study, the large-calibre transanal tube drainage and decompression is effective in protecting rectal anastomosis and decreasing the rate of anastomotic leakage.
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.
【Abstract】ObjectiveTo study the positive effect of recombinant human epidermal growth factor (rhEGF) on rabbit intestinal anastomotic wound healing after bowel resection. MethodsFortyeight white rabbits were randomly divided into study group in which rhEGF was injected and spinged in the submucosa and mucosa respectively during intestinal anastomosis after bowel resection, and control group in which only intestinal resection and anastomosis was performed. The leukocyte was counted. The incidence of anastomotic leakage and the synthesis of collagen fibrils and hydroxyproline were observed. ResultsThe leukocyte numbers in the anastomotic tissue in two groups rabbits increased slightly 3 d, 5 d and 7d after intestinal anastomosis, but the difference between study group and control group was insignificant (Pgt;0.05). The incidence of anastomotic leakage in the control group (16.7%) was higher than that of the study group (4.3%). The area of collagen fibrils 3 d, 5 d and 7d after intestinal anastomosis in the study group were significantly more than that in the control group (P＜0.05). Number of fibroblast was higher in the study group and the cells appeared bigger nucleus and dense colouration as well as enriched plasm. Angiogenesis in anastomosis tissue in the study group was significant and normal structure was present. Cell structure of anastomosis mucosa was damaged in the control group. Synthesis of hydroxyproline in anastomotic tissue 5 d and 7 d after anastomosis in the study group was more than that in the control group (P＜0.05).ConclusionInflammation was present in the whole process of wound healing, and local using of EGF had insignificant effect on system inflammation. EGF functions as chemoattractant and increases the recruitment of leukocytes, monocytes and fibroblasts into the wound area. EGF increases the production of collagen, angiogenesis and the synthesis of hydroxyproline. So EGF could promote wound healing and protect from anastomosis leakage in this study.
ObjectiveTo evaluate clinical value of colon leakage score (CLS), a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery. MethodsThe clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic (ROC) curve analysis. Resultsa total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage (14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000). The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 (95% CI 0.924-0.991). The best cut off value of CLS was 10 (The Youden index was 0.867). The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage (P<0.05). ConclusionThe preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.