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An integrated strategy for reducing anastomotic leakage in patients undergoing McKeown esophagectomy.
Zhang, Yan; Wang, Junya; Ren, Shuang; Jiao, Jia; Ding, Zheng; Yang, Hang; Pan, Dabo; Li, Jindong; Zhang, Guoqing; Li, Xiangnan; Zhao, Song.
Afiliação
  • Zhang Y; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Wang J; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Ren S; Department of Oncology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Jiao J; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Ding Z; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Yang H; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Pan D; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Li J; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Zhang G; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Li X; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
  • Zhao S; Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
Heliyon ; 10(4): e26430, 2024 Feb 29.
Article em En | MEDLINE | ID: mdl-38404844
ABSTRACT

Objective:

To describe our experience of reducing anastomotic leakage, a problem that has not been properly solved.

Methods:

Starting in January 2020, we began implementing our integrated strategy (application of an esophageal diameter-approximated slender gastric tube, preservation of the fibrous tissue around the residual esophagus and thyroid inferior pole anastomosis) in consecutive patients undergoing esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube. Additionally, the blood supply at the site of the anastomosis was evaluated with a near-infrared fluorescence thoracoscope after the completion of esophagogastric anastomosis in the integrated strategy group.

Results:

Of 570 patients who were reviewed, 119 (20.9%) underwent the integrated strategy, and 451 (79.1%) underwent the conventional strategy. The rate of anastomotic leakage was 2.5% in the integrated strategy group and 10.2% in the conventional strategy group (p = 0.008). In the integrated strategy group, the site of most of the anastomotic blood supply was the residual esophagus dominant (82.4%), followed by the gastroesophageal dual-dominant (12.6%) and the gastric tube dominant (5.0%). The reconstruction route was more likely to be orthotopic in the integrated strategy group than in the conventional strategy group (89.9% vs. 38.6%, p = 0.004). Gastric dilation was identified in 3.4% of the patients in the integrated strategy group and in 21.1% in the conventional strategy group.

Conclusions:

Patients who underwent our proposed integrated strategy (Zhengzhou Strategy) during McKeown esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube had a strikingly lower rate of anastomotic leakage and a relatively lower rate of postoperative complications, such as gastric tube dilation and delayed gastric emptying.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article