Abstract: Objective:To investigate the application value of tubular gastric interposition for esophageal reconstruction in esophageal and gastric cancer.
Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 6 patients with esophageal and gastric cancer who were admitted to the General Hospital of Jinan Military Area of PLA between January 2013 and December 2016 were collected. Among 6 patients, 2 and 4 were respectively confirmed as midthoracic and low esophageal cancers; tumors of 4 and 3 patients were respectively located in the gastric antrum and gastric body at lesser curvature side, including 1 with tumor in the gastric antrum and body. Esophageal cancer and gastric tumor were simultaneous resected, and proximal stomach replaced esophagus resected, with a blood-supply through right gastroepiploic vessels. There was an anastomosis between proximal tubular stomach and esoghagus. According to resection extent of resection extent, distal anastomosis included: (1) tubular stomachduodenum BillrothⅠ anastomosis in case 1; (2) tubular stomachjejunum Billroth Ⅱ anastomosis in case 2, 3 and 4; (3) tubular stomachjejunum Billroth Ⅱ anastomosis + jejunum-jejunum side-to-side anastomosis in case 5 and 6. Observation indicators: (1) intra-and post-operative recovery situations; (2) postoperative pathological examination; (3) followup and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and quality of life up to May 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range).
Results:(1) Intra and postoperative recovery situations: 6 patients underwent successful operation. The operation time, volume of intraoperative blood loss, gastrointestinal function recovery time, drainagetube removal time and duration of hospital stay were respectively (206± 50)minutes, (106±24)mL, (3.8±2.1)days, (6.8±5.0)days and (12.5±4.2)days. Of 6 patients, 1 with postoperative aspiration pneumonia and 1 with incomplete intestinal obstruction were cured by medical treatment. There was no anastomotic complication. (2) Postoperative pathological examination: number of lymph node dissectted of 6 patients was 13±3. Case 2 had intraabdominal lymph node metastasis. Pathological type: esophageal cancers were comfirmed as squamous cell carcinomas, gastric tumor were comfirmed as adenocarcinomas in 5 patients and stromal tumor were in 1 patient. (3) Followup and survival situations: 6 patients were followed up for 5-28 months, with a median time of 14 months. During the followup, case 1 had severe symptom of reflux, and other 5 patients didn′t have symptoms of reflux. Case 2 died of abdominal metastasis at 11 months postoperatively, and other 5 patients had survival.
Conclusion:Tubular gastric interposition replacing esophagus resected is safe and feasible in esophageal and gastric cancer, easy to operate and consistent with the physiological characteristics, meanwhile, it will provide opportunities and options of radical resection.