Application of tubular stomach reconstruction via the posterior mediastinal approach in the Iovr-Lewis radical resection of esophageal cancer

Abstract

Objective To explore the surgical technique and analyze the clinical efficacy of tubular stomach reconstruction via the posterior mediastinal approach after Iovr-Lewis radical resection of esophageal cancer. Methods The clinical data of 63 patients with middle-lower esophageal cancer who were admitted to the First People's Hospital of Chengdu between April 2013 and April 2015 were retrospectively analyzed. All the patients underwent Iovr-Lewis radical resection of esophageal cancer and tubular stomach reconstruction via the posterior mediastinal approach. Video-assisted minithoracotomy (VAMT) was used for anastomosis of esophagus-gastric tube at the top of thorax after laparoscopic abdominal surgery, and then tubular stomach reconstruction via the posterior mediastinal approach was performed by placing gastric tube in the esophageal bed and closing the posterior mediastinal pleura. Patients received regular perioperative treatment. Intraoperative record included operation time, volume of blood loss, volume of blood transfusion and lymph nodes dissection. Postoperative anastomotic leakage was detected by observing thoracic drainage, symptoms of fever, chest pain and elevated hemogram, recovery of intestinal function and closed thoracic drainage-tube removal time. Follow-up was performed by telephone interview and outpatient examination up to April 2015, including with or without normal food intake, gastroesophageal reflux and tumor progression. Results All the patients underwent successful Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach without perioperative death and intraoperative blood transfusion. The average operation time, average volume of intraoperative blood loss and average number of lymph nodes dissected were 230 minutes, 300 mL and 16, respectively. Patients received gastric tube removal at postoperative day 2 with a good condition of tubular stomach by CT examination. The average time of postoperative gastrointestinal tract recovery was 3 days. Patients took fluid diet at postoperative day 3-4, soft diet at postoperative day 7 and regular diet at postoperative day 10-12. Two patients complicated with slight pulmonary infection were cured by conventional treatment. The closed thoracic drainage-tube removal time was 4 days. All the patients were followed up for a median time of 8 months (range, 1-24 months) with regular diet intake and without perioperative death, tumor recurrence, severe gastroesophageal reflux and other complications. Conclusions Iovr-Lewis radical resection of esophageal cancer using tubular stomach reconstruction via the posterior mediastinal approach is safe and feasible, with the advantages of preventing the esophageal anastomotic fistula, reducing postoperative pulmonary infection and promoting early diet intake and enhancing postoperative recovery of patients. Key words: Esophageal neoplasms; Anastomtic fistula; Enhanced recovery