Abstract: Objective:To investigate the application value of the curved cutter stapler device combined with transorally inserted anvil (OrVil) in the radical resection of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG).
Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 206 patients with Siewert type Ⅱ AEG who were admitted to the Henan Tumor Hospital between March 2011 and March 2016 were collected. All the 206 patients underwent radical resection and 3step clock wise total gastrectomy D₂ lymph node dissection. Observation indicators: (1) surgery and postoperative recovery situations: surgical approach, overall operation time, hammer anvil placing time, esophagojejunal anastomosis time, volume of intraoperative blood loss, number of lymph node dissected, time to anal exsufflation, postoperative complications and duration of postoperative hospital stay; (2) postoperative pathological examination and chemotherapy; (3) followup and survival situations. Followup using telephone interview and outpatient examination was performed to detect tumorfree survival of patients up to April 2016. Measurement data with normal distribution were represented as ±s. The survival rate was calculated by the KaplanMeier method.
Results:(1) Surgery and postoperative recovery situations: all the 206 patients received successful operations, including 85 with abdominal operation, 50 with abdominal incision through the diaphragmatic muscle into thoracic surgery and 71 with thoracicabdominal surgery. Overall operation time, hammer anvil placing time, esophagojejunal anastomosis time, volume of intraoperative blood loss, number of lymph node dissected, time to anal exsufflation and duration of hospital stay were (113.7±15.4)minutes, (3.5±1.2)minutes, (10.4±2.9)minutes, (128±25)mL, 32±6, (2.4±0.9)days and (12.3±1.9)days, respectively. Of 206 patients, 15 with postoperative complications were cured by conservative treatment, including 6 with implicit anastomotic fistula, 3 with dominant anastomotic fistula, 2 with pancreatic leakage, 2 with intestinal obstruction, 1 with anastomotic stenosis and 1 with thoracic and abdominal infection. There was no reoperation due to perioperative complications. (2) Postoperative pathological examination and chemotherapy: postoperative pathological results showed that distance from resection margin of the esophagus to tumor was (5.2±0.4)cm, without cancer cells in the resection margin. Among 206 patients, 171 received postoperative chemotherapy by S1 single agent combined with oxaliplatin for 6 - 8 cycles or oral S1 single agent for 1 year. (3) Follow-up and survival situations: 206 patients were followed up for (2.7±0.3)years, with a tumorfree 3-year survival rate of 58%. During the followup, there was no recurrent anastomotic tumor.
Conclusion:The curved cutter stapler device combined with OrVil in the radical resection of Siewert type Ⅱ AEG can simplify the difficulty of esophagojejunal anastomosis and guarantee the safe resection margin of the lower esophagus.