Comparison of the subtotal and narrow gastric conduit for cervical esophagogastrostomy after esophagectomy in esophageal cancer patients: a propensity score-matched analysis,Esophagus

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Comparison of the subtotal and narrow gastric conduit for cervical esophagogastrostomy after esophagectomy in esophageal cancer patients: a propensity score-matched analysis
Esophagus ( IF 2.2 ) Pub Date : 2023-10-13 , DOI: 10.1007/s10388-023-01027-7
Ken Sasaki ₁ , Yusuke Tsuruda ₁ , Masataka Shimonosono ₁ , Masahiro Noda ₁ , Yasuto Uchikado ₁ , Itaru Omoto ₁ , Tetsuro Setoyama ₁ , Daisuke Matsushita ₁ , Takaaki Arigami ₁ , Kenji Baba ₁ , Hiroshi Kurahara ₁ , Takao Ohtsuka ₁

Affiliation

Background

Several reports have compared narrow gastric conduit (NGC) with subtotal gastric conduit (SGC) for cervical esophagogastrostomy after esophagectomy; however, whether which one is more beneficial in terms of postoperative complications remains unclear. To determine the optimal gastric conduit type, we retrospectively investigated and compared the postoperative complications between NGC and SGC used in cervical circular-tapered esophagogastrostomy after esophagectomy through a propensity score-matched analysis.

Methods

Between 2008 and 2022, 577 consecutive esophageal cancer patients who underwent esophagectomy and cervical circular-stapled esophagogastrostomy were enrolled in this study.

Results

Of the 577 patients, 77 were included each in the SGC and NGC groups, after propensity score matching. Clinical characteristics did not differ between the two groups. The anastomotic leakage rate was significantly lower in the SGC group than in the NGC group (5% vs. 22%, p < 0.01). The anastomotic stenosis rate was significantly higher in the SGC group (16% vs. 5%, p = 0.03). Multivariate logistic analysis showed that NGC, subcutaneous route, and age were significant independent factors associated with anastomotic leakage (odds ratios, 8.58, 6.49, and 5.21; p < 0.01, < 0.01 and 0.03, respectively) and that SGC was a significant independent factor associated with anastomotic stricture (odds ratios, 4.91; p = 0.04).

Conclusions

In cervical circular-stapled esophagogastrostomy after esophagectomy, SGC was superior to NGC in terms of reducing the risk of anastomotic leakage, although the risk of anastomotic stricture needs to be resolved.

中文翻译：

食管癌患者食管切除术后颈段食管胃造口术中胃大部导管与狭窄胃导管的比较：倾向评分匹配分析

背景

一些报告比较了食管切除术后颈部食管胃造口术中的窄胃导管（NGC）与胃大部导管（SGC）；然而，就术后并发症而言，哪种方法更有益仍不清楚。为了确定最佳的胃导管类型，我们通过倾向评分匹配分析，回顾性地调查和比较了食管切除术后颈椎锥形食管胃造口术中NGC和SGC的术后并发症。

方法

2008年至2022年间，连续577例接受食管切除术和颈部环形吻合器食管胃吻合术的食管癌患者纳入本研究。

结果

在倾向评分匹配后，577 名患者中，SGC 组和 NGC 组各有 77 名患者。两组之间的临床特征没有差异。 SGC 组的吻合口漏率显着低于 NGC 组（5% vs. 22%， p < 0.01）。 SGC 组的吻合口狭窄率显着较高（16% vs. 5%， p = 0.03）。多变量逻辑分析显示，NGC、皮下途径和年龄是与吻合口漏相关的显着独立因素（比值比分别为 8.58、6.49 和 5.21； p < 0.01、< 0.01 和 0.03），而 SGC 是一个显着独立因素与吻合口狭窄相关（比值比，4.91； p = 0.04）。