Incidence Of Anastomotic Fistula Research Articles

408. COMPARISON OF THE SHORT-TERM EFFICACY OF THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY IN THE TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE

Abstract Background Early and thorough intrathoracic debridement，irrigation and catheter drainage are of great significance for the healing of esophageal rupture. This study aims to explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate. Methods A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy. Results Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P < 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P > 0.05). Conclusion Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.

166. A STUDY OF THE LEARNING CURVE FOR LAPAROSCOPIC-ASSISTED SINGLE-PORT MEDIASTINOSCOPIC ESOPHAGECTOMY

Abstract Laparoscopic-assisted single-port mediastinoscopic esophagectomy is a safe and effective emerging minimally invasive esophagectomy. However, nothing has been reported about the learning curve for this technique. The goal of this study was to analyze the learning curve of this technique and to determine the number of procedures performed to achieve different levels of proficiency to improve surgeons’ understanding of the learning process of this new technique. This study retrospectively collected clinical data on consecutive laparoscopic-assisted single-port mediastinoscopic esophagectomies performed by the same surgeon at our center from October 2016 to August 2021. A simple scatter plot of the number of procedures versus procedure time and its trend line were plotted, using procedure time as an indicator of efficiency. Learning curves were quantitatively assessed by unadjusted cumulative sum values using the cumulative summation method, different segments were derived using joint point linear regression analysis, and variables were compared between subgroups using trend analysis. The survival analysis was performed using the Kaplan–Meier method. The learning curve could be divided into 3 different stages: the 1st–91st, 91st-125th, and 125th-182nd procedures comprised the preliminary, transition, and proficient stages, respectively. Compared with the preliminary stage, the procedure time, bleeding volume, postoperative hospital stays, and the incidence of anastomotic fistula were significantly lower in the proficiency stage, whereas the number of harvested lymph nodes and the rate of recurrent laryngeal nerve lymph node harvest was significantly higher. Additionally, there were no significant differences in overall survival and disease-free survival at different stages for patients with all, different T stages, and different N stages within 1 year postoperatively. In this study, there may be 3 stages of varying proficiency in the learning curve of laparoscopic-assisted single-port mediastinoscopic esophagectomy. Approximately 91 consecutive procedures were required to overcome the preliminary stage, whereas proficiency in this technique required approximately 125 consecutive procedures. Moreover, as the learning curve reached the proficiency stage, the perioperative indicators tended to stabilize. Furthermore, the short-term survival of patients might not be influenced by technical proficiency.

A clinical study of inferior mesenteric artery typing in laparoscopic radical resections with left colonic artery preservation of rectal cancer

ObjectivesAn investigation of the effects of different types of the inferior mesenteric artery (IMA) on laparoscopic left colic artery (LCA) radical resection of rectal cancer was conducted.MethodsClinical data were collected from 92 patients who underwent laparoscopic radical resection of rectal cancer with preservation of the LCA at Nantong University’s Second Affiliated Hospital. All patients underwent full-abdominal dual-energy CT enhancement examination before surgery and 3D post-processing reconstruction of the IMA. Two radiologists with >3 years of experience in abdominal radiology jointly conducted the examination. A total of three types of IMA were identified among the patients: IMA type I (the LCA arising independently from the IMA), type II (LCA and sigmoid colon artery [SA] branching from a common trunk from IMA), and type III (LCA, SA, and superior rectal artery [SRA] branching from the IMA at the same point). The baseline data, pathological results, and intra-operative and post-operative indicators of the groups were analyzed.ResultsThe proportions of type I, type II, and type III IMA were 58.70% (54/92), 18.48% (17/92), and 22.82% (21/92), respectively. IMA typing was consistent with the preoperative CT evaluation results. The intra-operative blood loss of type III IMA patients [median (interquartile spacing), M (P25, P75): 52.00 (39.50, 68.50) ml] was higher than that of type I and II IMA patients [35.00 (24.00, 42.00) and 32.00 (25.50, 39.50) ml, respectively] (P<0.05). The incidence of anastomotic fistula in type III IMA patients (4 cases, 19.05%) was higher than that in non-type III IMA patients (1 case, 1.41%) (X2=6.679, P=0.010). The incidence of postoperative complications among the three types of IMA was not significantly different (P>0.05).ConclusionsAmong rectal cancer patients undergoing laparoscopic LCA preservation, type III IMA patients had more intraoperative bleeding and a higher incidence of postoperative anastomotic fistula. However, this did not increase the risk of overall postoperative complications.

Risk Factors of Enterostomy Infection Caused by Bacterial Infection through Mathematical Modelling-Based Information Data Analysis.

Objective The study aimed to explore the risk factors of infections after enterostomy through the information data analysis method based on a mathematical model. Methods 156 cases of enterostomy patients admitted to the hospital were retrospectively selected as the study subjects and were divided into the infection group (17 cases) and normal group (139 cases) according to whether they were complicated with infections. Then, the factors of infection and related indexes before and after surgery were analyzed, and the data of the whole hospital were estimated by mathematical modelling. Results The length of hospital stay in the infection group was 21 ± 11.2 days, which is longer than 10.1 ± 7.1 days in the normal group (P < 0.05). The incidence of anastomotic fistula in the infection group was 14%, which is higher than 2% in the normal group. The mortality rate of infection group (44%) was higher than that of normal group (5%). In the infection group, the incidence of single-cavity stoma (69%) was higher than that of double-cavity stoma (31%), the nosocomial infection rate (11%) was significantly higher compared with out of hospital (2%), and there were significant differences (P < 0.05). Conclusions Patients with malnutrition and hypoproteinemia before enterostomy, the use of gastric tube and ventilator in the treatment, single lumen stomy in the operation, and the occurrence of anastomotic fistula were more likely to have concurrent infections.

Sternal lifting increases the operating space in esophagectomy via mediastinoscopy: a prospective cohort study.

BackgroundEsophagectomy with combined single-port inflatable mediastinoscopy and laparoscopy reduces the risk of postoperative respiratory complications as it obviates the need to pass through the pleural space. However, it has strict indications owing to the narrow space for operation. Therefore, we adopted a sternal lifting method using a retractor that enables the expansion of the operating space, a technique which has not been previously reported. We describe our experience and report the results of an evaluation of this new approach.MethodsThirty-nine patients with esophageal squamous cell carcinomas underwent esophagectomy using combined single-port inflatable mediastinoscopy and laparoscopy from March 2019 to August 2021. Among them, 20 cases received sternal suspension [sternal suspension group (SS group)], and 19 cases did not receive sternal suspension [non-sternal suspension group (NSS group)]. The short-term efficacy of the two groups was observed.ResultsPatients in the SS group had a shorter intramediastinal operation time (82.50 vs. 110.00 minutes; P<0.001), more dissected chest lymph nodes (14 vs. 12; P=0.036), and a lower incidence of postoperative hoarseness (2 vs. 6; P=0.235) than did those in the NSS group. There were no significant differences between the SS group and NSS group in terms of intraoperative blood loss, postoperative hospital stay, post-surgical pathologic TNM classification (pTNM), post-surgical pathologic tumor classification (pT), post-surgical pathologic extent of lymph node involvement (pN), and total number of dissected lymph nodes. There were no statistical differences in the incidence of anastomotic fistula, respiratory complications, arrhythmia, or chylothorax between the two groups. There was no mortality during hospitalization in the two groups.ConclusionsSternal lifting increases the working space in esophagectomy via mediastinoscopy. It can make video-assisted radical esophagectomy by a transmediastinal approach with total pneumomediastinum assistance (VARETT) easier to perform, and sternal suspension in VARETT is safe and effective.

Risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia

BackgroundOesophageal atresia is a congenital malformation of the oesophagus and a serious malformation of the digestive system, postoperative complications include acute respiratory failure, pneumonia, anastomotic fistula, anastomotic stenosis, tracheal stenosis, gastroesophageal reflux and eosinophilic oesophagitis, anastomotic fistula is one of the important causes of postoperative death. The objective of this study is to identify the risk factors for anastomotic complications after one-stage anastomosis for oesophageal atresia.MethodsA retrospective analysis was performed on the clinical data of 107 children with congenital oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2013 to December 2018. Single-factor and multivariate logistic regression analyses were performed to determine the risk factors for anastomotic fistula and anastomotic stenosis.ResultsA total of 107 children with oesophageal atresia underwent one-stage anastomosis, and the incidence of anastomotic fistula was 26.2%. The probability of anastomotic stenosis in the long term was 52.3%, and the incidence of refractory stenosis (dilation ≥5 times) was 13.1%. Analysis of the clinical count data in the anastomotic fistula group and non-anastomotic fistula group showed that preoperative albumin (F = 4.199, P = 0.043), low birth weight (F = 7.668, P = 0.007) and long gap defects (F = 6.107, P = 0.015) were risk factors for postoperative anastomotic fistula. Further multivariate logistic regression analysis showed that low birth weight (Wald2 = 4.499, P = 0.034, OR = 2.775) and long gap defects (Wald2 = 6.769, P = 0.009, OR = 4.939) were independent risk factors for postoperative anastomotic fistula. Premature delivery (F = 5.338, P = 0.023), anastomotic fistula (F = 11.381, P = 0.001), endoscopic surgery (F = 6.343, P = 0.013), preoperative neutrophil count (F = 8.602, P = 0.004), preoperative low albumin (F = 8.410, P = 0.005), and a preoperative prognostic nutritional index < 54 (F = 5.54, P = 0.02) were risk factors for refractory anastomotic stenosis in children. Further multivariate logistic regression analysis showed that postoperative anastomotic fistula (Wald2 = 11.417, P = 0.001, OR = 8.798), endoscopic surgery (Wald2 = 9.633, P = 0.002, OR = 4.808), and a prognostic nutritional index < 54 (Wald2 = 4.540, P = 0.002, OR = 2.3798) were independent risk factors for refractory anastomotic stenosis.ConclusionLow birth weight and long gap defects are important predictors of postoperative anastomotic fistula, and the possibility of refractory anastomotic stenosis should be considered. The long-term risk of anastomotic stenosis was increased in children undergoing endoscopic surgery and in those with a preoperative prognostic nutritional index < 54.

Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: a single-center initial experience

BackgroundWe aimed to compare mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with thoraco-laparoscopic esophagectomy (TLE) for patients with esophageal cancer in terms of the clinical effectiveness and perioperative complications.MethodsIn total, 98 patients who underwent esophagectomy consecutively for esophageal squamous cell carcinoma in our center from Jan. 2018 to Dec. 2019 were included in this study. Thirty patients underwent mediastinoscopy-assisted and laparoscopic transhiatal esophagectomy with cervical anastomosis (the MATHE group). The other sixty-eight patients received TLE (the TLE group). Each patient’s general conditions and perioperative complications were recorded.ResultsPatients in the MATHE group were observed to have a higher incidence of postoperative hoarseness than those in the TLE group. There were no significant differences between the MATHE group and the TLE group in regards to the operation time, intraoperative blood loss, number of lymph nodes dissected or postoperative hospital stay. Similarly, no statistically significant differences were observed in the incidence of anastomotic fistula, respiratory complications, or chylothorax or in the conversion rate or in-hospital mortality rate between the two groups.ConclusionsThe short-term efficacy in the MATHE group was similar to that in the TLE group, although patients in the MATHE group may have had a higher incidence of postoperative hoarseness. Therefore, MATHE may be a feasible and safe surgical procedure for appropriate patients with esophageal cancer.

Neoadjuvant mFOLFOXIRI chemotherapy-improved survival benefit comparing with CRT in locally advanced rectal cancer: A propensity score matched analysis from two prospective trials.

98 Background: Neoadjuvant chemoradiotherapy (CRT) is the standard of treatment for locally advanced rectal cancer, but it delays administration of systemic chemotherapy, leading to high incidence of distant metastases. To enhance systemic chemotherapy and avoid the damage of radiation, neoadjuvant chemotherapy with mFOLFOXIRI had been investigated. However, no randomized comparison assessing the efficacy of mFOLFOXIRI versus CRT in LARC. Methods: 145 LARC patients received CRT as neoadjuvant treatment in the phase III FOWARC study (NCT01211210) and 103 patients received mFOLFOXIRI alone preoperatively in a phase II study (NCT02217020). A propensity score-adjusted method was adopted to provide an estimation of the benefit from the enhancive chemotherapy regimen as neoadjuvant treatment in terms of survival and activity parameters. Results: In the original cohort, patients in the mFOLFOXIRI group were younger with the median age of 48 versus 56 years old in the CRT group. More patients with tumor length over 5 cm and cT3 or N2 disease in the mFOLFOXIRI group ( P&lt; 0.05). After propensity score adjusted matching, 73 patients were comparable in each groups. The pCR rate was 23.3% in thd mFOLFOXIRI group versus 13.7% in the CRT group, respectively (P = 0.14). The proportion of ypStage 0-I was 45.2% versus 39.7%, respectively (P = 0.5). The local recurrence rate was comparable between the two groups (5.5% vs. 4.1%, P= 0.70). But mFOLFOXIRI decrease the incidence of distant metastasis (8.2% vs. 27.4%, P= 0.002). And the 3 year disease free survival was 86.8% in the mFOLFOXIRI group versus 75.8% in the CRT group, respectively ( P= 0.049). Lower incidence of anastomotic fistula was shown in mFOLFOXIRI alone group than that of CRT group (5.5% vs. 17.8%, P = 0.02). Grade 3/4 neutropenia was more commen in mFOLFOXIRI group (39.7% vs. 8.2%, P &lt; 0.001). Conclusions: Comparing with CRT, preoperative mFOLFOXIRI decreased the incidence of distant metastasis and improved 3 year DFS, and led to less toxicity and fewer postoperative complications. The phase III randomized study comparing FOLFOXIRI with CRT is still ongoing. Clinical trial information: NCT01211210 and NCT02217020.

Risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy of esophageal cancer

Objective To investigate the risk factors of cervical esophagogastric anastomotic fistula after esophagectomy of esophageal cancer. Methods The retrospective case-control study was conducted. The clinicopathological data of 956 patients who underwent esophagectomy and cervical esophagogastrostomy from January 2012 to December 2016 in the First Affiliated Hospital of Zhengzhou University were collected. Patients underwent Sweet or Mckeown surgery. Observation indicators: (1) intra- and post-operative situations; (2) the risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy; (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the esophagogastric anastomotic stenosis of patients up to February 2017. Measurement data with normal distribution were represented as the ±s. Univariate analysis and comparison of count data were done using the chi-square test or Fisher exact probability method. Multivariate analysis was done using the Logistic regression model. Results (1) Intra- and post-operative situations: all the 956 patients underwent successful operations, including 107 with Sweet operation and 849 with Mckeown operation. Of 956 patients, 336 received thoracotomy and 620 received thoracoscopic surgery. Tumors located in upper, middle and lower esophagus were respectively detected in 143, 627 and 186 patients. Operation time, volume of intraoperative blood loss and number of lymph node dissected in 956 patients were (274±67)minutes, (210±167)mL and 18±11, respectively. Of 956 patients, 117 had cervical esophagogastric anastomotic fistula, with an incidence of anastomotic fistula of 12.24% (117/956). Of 117 patients with cervical esophagogastric anastomotic fistula, 2 had early stage fistula, 110 had middle stage fistula and 5 had later stage fistula; 12 were cured by two-tube method (stomach tube and nutrition tube), 24 were cured by three-tube method (stomach tube, nutrition tube and chest tube or mediastinal tube), 43 were cured by open neck incision dressing, 15 were cured by fistula cavity drainage and 17 were cured by esophageal stent implantation. Sixteen patients died in hospital postoperatively, including 6 with cervical esophagogastric anastomotic fistula and 10 without cervical esophagogastric anastomotic fistula. Duration of hospital stay of 956 patients was (16±11)days, and durations of hospital stay of patients with and without cervical esophagogastric anastomotic fistula were (39±19)days and (13±6)days. Postoperative pathological examinations: 873, 9 and 74 patients were respectively diagnosed with squamous cell carcinoma, adenocarcinoma and other types of cancer. TNM staging: stage 0, Ⅰ, Ⅱ, Ⅲ, Ⅳ and unidentified stage were respectively detected in 135, 110, 325, 376, 1 and 10 patients. (2) The risk factors analysis of cervical esophagogastric anastomotic fistula after esophagectomy: univariate analysis showed that gender, age, history of diabetes, surgical method, tubular stomach production, operation time, postoperative pulmonary infection and postoperative aspirating sputum through fiberbronchoscope were risk factors affecting cervical esophagogastric anastomotic fistula after esophagectomy, with statistically significant differences (χ2=4.179, 6.174, 4.427, 4.377, 6.266, 7.057, 55.036, 51.806, P<0.05). Multivariate analysis showed that tubular stomach production, postoperative pulmonary infection and aspirating sputum through fiberbronchoscope were independent risk factors affecting cervical esophagogastric anastomotic fistula after esophagectomy, with statistically significant differences (OR=1.922, 2.907, 2.323, 95% confidence interval: 1.203-3.070, 1.682-5.023, 1.235-4.370, P<0.05). (3) Follow-up situations: 908 of 956 patients were followed up for 2-62 months, with a median follow-up time of 28 months. During the follow-up, 21 of 111 patients with cervical esophagogastric anastomotic fistula were complicated with cervical esophagogastric anastomotic stenosis, 59 of 797 patients without cervical esophagogastric anastomotic fistula were complicated with cervical esophagogastric anastomotic stenosis, showing a statistically significant difference in cervical esophagogastric anastomotic stenosis (χ2=16.803, P<0.05). Conclusion Tubular stomach production, postoperative pulmonary infection, postoperative aspirating sputum through fiberbronchoscope are independent risk factors affecting cervical esophagogastric anastomotic fistula after esophagectomy. Key words: Esophageal neoplasms; Neck; Esophagogastric anastomotic fistula; Risk factors

Surgical Method, Postoperative Complications, and Gastrointestinal Motility of Thoraco-Laparoscopy 3-Field Esophagectomy in Treatment of Esophageal Cancer.

BackgroundThe aim of this study was to investigate the surgical method, postoperative complications, and gastrointestinal motility of thoraco-laparoscopic esophagectomy in the treatment of esophageal cancer.Material/MethodsUsing random sampling method, we selected 132 esophageal cancer patients who were treated in our hospital from January 2012 to December 2014; these patients were regarded as the study group and underwent thoraco-laparoscopy 3-field surgery treatment. Another 108 esophageal cancer patients admitted to our hospital over the same period were regarded as the control group and underwent traditional open McKeown esophagectomy.ResultsThe amount of blood loss and postoperative drainage of pleural fluid in the study group were significantly lower (P<0.05) and the time to removal of the chest tube and hospital stay were significantly shorter (P<0.05). The incidence of anastomotic fistula, vocal cord paralysis, chylothorax, and arrhythmia were significantly lower in the study group than in the control group (P<0.05). However, no significant differences in the incidence of pneumonia, atelectasis, or acute respiratory distress were detected (P>0.05). For postoperative gastrointestinal motility, first flatus time, first defecation time, and bowel tone recovery time after the operation, as well as the total amount of gastric juice draining, were reduced in the thoraco-laparoscopic esophagectomy group (P<0.05). The postoperative MTL and NO levels were higher but VIP level was lower in the thoraco-laparoscopic group (P<0.05).ConclusionsThoraco-laparoscopic esophagectomy was technically feasible and safe; it was associated with lower incidence of certain postoperative complications and had less effect on postoperative gastrointestinal motility. Skilled technique and cooperation could further shorten the operation time and might lead to better patient outcomes.

Surgical Repair of Mid-shaft Hypospadias Using a Transverse Preputial Island Flap and Pedicled Dartos Flap Around Urethral Orifice.

To evaluate the effects, particularly the incidence of anastomotic fistula, of a pedicled dartos flap around the urethral orifice in the treatment of urethroplasty of mid-shaft hypospadias. A total of 46 cases of congenital mid-shaft hypospadias were included in this study. The patients ranged in age from 0.7 to 25.4years and the average was 5.8years. The patients received penis chordee correction. A transverse preputial island flap was developed for urethral reconstruction. The proximal dartos of the urethral orifice was used to develop a pedicled dartos flap, which was transposed to cover and strengthen neourethral anastomosis. The ventral penile skin defect was repaired by another flap. The 46 patients were examined during follow-up visits for 6months to 3years. An anastomotic fistula was observed in one case (2.2%). Scar healing without fistula was observed in another patient due to poor blood supply to part of the ventral penile skin. No other incidences of fistula, urethral rupture, flap necrosis, wound infections, urinary tract (meatal) stenosis, or urethral diverticulum were observed in the patients. A pedicled dartos flap around the urethral orifice can take advantage of well-vascularized local tissue to add a protective layer to the proximal aspect of the neourethral anastomosis for reducing the incidence of anastomotic fistula in mid-shaft hypospadias repair using a transverse preputial island flap. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Discussion on the strategies of common hepatic artery lymph node dissection for thoracic esophageal squamous cell carcinoma

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery. Key words: Esophageal neoplasms; Common hepatic artery lymph node; Lymph node dissection

Clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula

Objective To investigate the clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula.Methods The clinical data of 133 patients with high risk of intestinal anastomotic stoma who were admitted to the Henan Tumor Hospital from May 2009 to May 2012 were retrospectively analyzed.All patients were divided into the improvement group (69 patients) and the control group (64 patients) according to whether the anastomotic stoma was covered by pedicled omentum.All the operations were done by the surgeons in the same group,and the intestinal reconstruction was done by the equipment produced by the same company.All the patients with intestinal tumors received radical resection.The clinical data of the patients in the 2 groups were reviewed and the therapeutic effects of the 2 approaches were compared.All data were analyzed using the chi-square test.Results Three (4.3％) patients had intestinal fistula in the improvement group,including 1 had small bowel anastomotic fistula,1 had small bowel and colonic anastomotic fistula,1 had colonic anastomotic fistula.Eight (12.5％) patients in the control group had intestinal anastomotic fistula,including 1 had duodenal anastomotic fistula,2 had small bowel anastomotic fistula,2 had small bowel and colonic anastomotic fistula,and 3 had colonic anastomotic fistula.There was a significant difference in the incidence of anastomotic fistula between the 2 groups (x2 =5.483,P ＜ 0.05).The highest body temperatures of the 3 patients in the improvement group were under 38.2 ℃,and the mean white blood cell count was 8.4 × 109/L;no peritonitis was detected; turbid drainage was observed in the peritoneal tube around the anastomotic stoma.The results of computed tomography showed local inflammation.The highest body temperatures of the 8 patients in the control group were above 38.5 ℃,and the mean white blood cell count was 14.4 × 109/L; obvious pressing pain and rebound tenderness were detected; intestinal contents were observed in the peritoneal drainage tube.The 3 patients in the improvement group were cured by symptomatic treatment.Of the 8 patients in the control group,7 received two-stage debridement,and 1 received jejunostomy and 3 received ileostomy.The condition of the 7 patients was recovered after operation,and reversion of the ileum at postoperative month 4.One patient died of multiple organs dysfunction syndrome and systemic inflammatory response syndrome.Conclusion Intestinal anastomotic stoma covered by pedicled omentum could effectively decrease the incidence of anastomotic fistula and alleviate systemic inflammatory response syndrome caused by anastomotic fistula. Key words: Anastomotic fistula; Pedicled omentum; Peritonitis

Application of modified loop ileostomy in laparoscopic low and super-low radical resection of the rectal cancer with preservation of anus

Objective To investigate the value of modified loop ileostomy in laparoscopic low and superlow radical resection of the rectal cancer with reservation of anus.Methods The clinical data of 108 patients who received laparoscopic low and super-low radical resection of rectal cancer with preservation of anus at the Subei Hospital of Jiangsu Province from January 2010 to June 2012 were retrospectively analyzed.Fifty-three patients who received preventive ileostomy were in the ileostomy group,and 55 patients who did not receive preventive ileostomy were in the non-ileostomy group.The operation,incidence of complication and follow-up of the 2 groups were analyzed.All data were analyzed using the t test,chi-square text or Fisher exact test.Results The operation time and blood loss were (185 ± 14)minutes and (31 ± 26)ml in the ileostomy group,and (154 ± 12)minutes and (28 ± 19)ml in the non-ileostomy group,with no significant difference between the 2 groups (t =2.34,1.82,P ＞ 0.05).The time to first flatus,time to liquid diet intake,time to pelvic drainage tube removal,duration of hospital stay,hospital costs were (1.1 ± 0.3) days,(1.1 ± 0.2) days,(5.2 ± 1.0) days,(7.2 ± 1.4) days,(3.0 ± 0.2) ×104 yuan in the ileostomy group,and (4.2 ± 0.6) days,(4.3 ± 0.6) days,(8.4 ± 3.9) days,(12.9 ±4.4)days,(3.8 ±0.7) × 104 yuan in the non-ileostomy group,with significant differences between the 2 groups (t =7.25,28.12,15.34,34.01,7.83,P ＜ 0.05).The incidences of postoperative complications and anastomotic fistula were 5.7％ (3/53) and 0 in the ileostomy group,and 21.8％ (12/55) and 12.7％ (7/55) in the non-ileostomy group,with significant differences between the 2 groups (P ＜ 0.05).Conclusion Modified loop ileostomy in laparoscopic low and super-low radical resection of rectal cancer can effectively reduce the incidence of anastomotic fistula,and helps the recovery of patients. Key words: Rectal neoplasms; Laparoscopy; Ileostomy

Efficacy of circinal stapled suture and manual suture in cervical esophagogastric anastomosis in esophageal resection

Objective To evaluate the efficacy of circinal stapled suture and manual suture in cervical esophagogastric anastomosis in esophageal resection.Methods The clinical data of 187 patients with esophageal cancer who were admitted to the Cancer Hospital of Sichuan Province from January 2010 to January 2012 were retrospectively analyzed.All the patients were divided into the stapled suture group (98 patients) and manual suture group (89 patients).The time of anastomosis,operation time,time for dieting,duration of hospital stay,the incidence of postoperative complications and positive rate of esophageal remnant cancer cells of the 2 groups were compared.All data were analyzed using the t test or chi-square test.Results The time of anastomosis,operation time,time for dieting and duration of hospital stay were (7.8 ± 1.4) minutes,(227 ± 60) minutes,(6.3 ± 0.9) days and (14 ±4)days in the stapled suture group,which were significantly shorter than (28.5 ±2.3)minutes,(301 ±81)minutes,(8.4 ± 1.0)days and (22 ±9) days in the manual suture group (t =75.44,7.14,7.71,7.41,P ＜0.05).The incidence of anastomotic fistula was 1％ (1/98) in the stapled suture group,which was significantly lower than 8％ (7/89) of the manual suture group (P ＜ 0.05).The incidence of anastomotic stricture was 5％(5/98) in the stapled suture group,which was lower than 7％ (6/89) in the manual suture group,but no significant difference was detected (P ＞0.05).The positive rate of esophageal remnant cancer cells was 0(0/98),which was signifiantly lower than 4％ (4/89) in the manual suture group (P ＜0.05).Conclusion Circinal stapled suture in esophagogastric cervical anastomosis not only reduce the time of anastomosis,operation time and duration of hospital stay,but also decrease the incidence of anastomotic fistula and the positive rate of esophageal remnant cancer cells. Key words: Esophageal neoplasms; Esophageal cancer resection; Esophagogastric cervical anastomosis ; Stapled suture; Manual suture

Risk Factors and Strategies of Anastomotic Fistula after Sphincter-Pre- serving Surgery for Laparoscopic Rectal Cancer

Objective: To study the risk factors and strategies of sphincter-preserving surgery after laparoscopic rectal cancer for reference. Methods: 80 patients who underwent laparoscopic rectal cancer from January 1, 2015 to December 31, 2016 were the subjects of this study, and the detailed analysis of 80 patients was retrospectively analyzed. The occurrence of anastomotic fistula and the number of patients did not occur into the ratio. Results: The results showed that anastomotic fistula occurred and the body weight index did not occur, preoperative albumin and other significant differences, p &lt; 0.05. Conclusion: The risk factors of anastomotic fistula include body mass index, preoperative albumin and so on. It is effective to reduce the incidence of anastomotic fistula in patients with risk factors.