Application of Pleural Tenting in Ivor-Lewis Esophagogastrectomy: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HEXiao-feng , XUWang-zi ,  CAOBin

Department of Thoracic-Cardio Surgery, Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing 210008, P. R. China;

Corresponding?author：

CAOBin, Email: Njglcb2001@163.com

Keywords：

Pleural tenting; Esophageal cancer; Quality of life; Anastomotic leak

DOI：

10.7507/1007-4848.20160243

Video：

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Objective To explore the superiority of pleural tenting in Ivor-Lewis esophagogastrectomy. Methods We prospectively included 200 esophagus cancer patients with Ivor-Lewis esophagogastrectomy in our hospital between 2013 and 2015 year. The patients were allocated into two groups including a trial group and a control group with 100 patients in each group. There were 72 males and 28 females at an average age of 54.76±6.62 years in the trial group and 66 males and 34 females at an average age of 55.72±6.38 years in the control group. In the trial group pleural tenting was used to cover the anastomotic stoma and gastric tube, while in the control group pleural tenting was not used. Postoperative complications after one year, pressure on the level of the anastomotic stoma, and the grade of quality of life were compared between the two groups. Result No statistically significant differences were found in preoperative epidemiological and postoperative pathological characteristics, as well as the postoperative complications and the one-year survival rate (P > 0.05). Quality of life was better in the trial group than that of the control group. Conclusion Pleural tenting is a simple, safe, and effective technique for improving quality of life of the patients.

Citation： HEXiao-feng, XUWang-zi, CAOBin. Application of Pleural Tenting in Ivor-Lewis Esophagogastrectomy: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1029-1033. doi: 10.7507/1007-4848.20160243 Copy

1.	Zhang H, Wang J, Wang W, et al. A meta-analysis of esophagec-tomy: the comparative study of Ivor-Lewis operation and Sweet operation. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 892-897.
2.	冒志明, 顧曉華, 李昌炎, 等. Ivor-Lewis經胸頸部機械吻合術治療中段食管癌的前瞻性研究.中華消化外科雜志, 2013, 12(10): 754-758.
3.	Lin J, Kang M, Lin J, et al. Short-term efficacy comparison between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 888-891.
4.	Uzzaman MM, Daniel RJ, Mhandu PC, et al. A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy. Ann Thorac Surg, 2014, 97(1): 365-372.
5.	Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis, 2014, 6(3): 271-284.
6.	郭予雄, 何少茹, 鐘敏泉, 等.小兒先天性心臟病術后乳糜胸的診斷和治療.中國胸心血管外科臨床雜志, 2015, 22(8): 734-738.
7.	Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
8.	Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesopha-gogastric anastomosis: single-centre analysis of 415 oesophagec-tomies. Eur J Cardiothorac Surg, 2016, 49(6): 1650-1659.
9.	孫振宇, 顧敏威, 趙永, 等.食管賁門癌術后胸內吻合口狹窄的臨床分析.南京醫科大學學報(自然科學版), 2010, 30(8): 1211-1213.
10.	De Giacomo T, Francioni F, Venuta F, et al. Complete mechanical cervical anastomosis using a narrow gastric tube after esophagec-tomy for cancer. Eur J Cardiothorac Surg, 2004, 26(5): 881-884.
11.	Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psycho-metric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
12.	楊國明, 王會志, 董駒, 等.賁門癌、食管癌切除術后食管-胃肌瓣胃腔內瓣膜式吻合術的測壓觀察.河北醫科大學學報, 2011, 32(6): 699-700.
13.	王文憑, 陳龍奇.食管癌外科治療的現狀與展望.中國胸心血管外科臨床雜志, 2011, 18(1): 58-65.
14.	Li B, Xiang J, Zhang Y, et al. Factors affecting hospital mortality in patients with esophagogastric anastomotic leak: a retrospective study. World J Surg, 2016, 40(5): 1152-1157.
15.	段紅兵, 李敏杰, 康健樂.管狀胃成形對預防食管癌切除術后胃食管反流的作用.中國胸心血管外科臨床雜志, 2010, 17(5): 417-419.
16.	臧其威, 鄭中鋒, 陳偉.食管胃高位胸頂吻合加縱膈胸膜減張覆蓋在食管癌手術中的應用.齊齊哈爾醫學院學報, 2010, 31(5): 708-709.
17.	Asteriou C, Barbetakis N, Lalountas M, et al. Modified pleural tenting for prevention of anastomotic leak after ivor lewis esopha-gogastrectomy. Ann Surg Oncol, 2011, 18(13): 3737-3742.
18.	姜志良, 楊繼武, 王林, 等.經食管床吻合術后對殘余食管的壓力測定和酸堿度分析.中華胃腸外科雜志, 2008, 11(1): 32-35.
19.	趙雍凡, 王資斌, 伍佇, 等.不同平面胃食管吻合術后食管腔內24小時pH監測.中國胸心血管外科臨床雜志, 1998, 5(3): 19-20.
20.	Honda M, Wakita T, Onishi Y, et al. development and validation of a disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer. Ann Surg Oncol, 2015, 22 (Suppl 3): 848-854.

1. Zhang H, Wang J, Wang W, et al. A meta-analysis of esophagec-tomy: the comparative study of Ivor-Lewis operation and Sweet operation. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 892-897.
2. 冒志明, 顧曉華, 李昌炎, 等. Ivor-Lewis經胸頸部機械吻合術治療中段食管癌的前瞻性研究.中華消化外科雜志, 2013, 12(10): 754-758.
3. Lin J, Kang M, Lin J, et al. Short-term efficacy comparison between Ivor-Lewis approach and McKeown approach in minimally invasive esophagectomy. Zhonghua Wei Chang Wai Ke Za Zhi, 2014, 17(9): 888-891.
4. Uzzaman MM, Daniel RJ, Mhandu PC, et al. A meta-analysis assessing the benefits of concomitant pleural tent procedure after upper lobectomy. Ann Thorac Surg, 2014, 97(1): 365-372.
5. Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis, 2014, 6(3): 271-284.
6. 郭予雄, 何少茹, 鐘敏泉, 等.小兒先天性心臟病術后乳糜胸的診斷和治療.中國胸心血管外科臨床雜志, 2015, 22(8): 734-738.
7. Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis. Surg Endosc, 2013, 27(10): 3530-3538.
8. Harustiak T, Pazdro A, Snajdauf M, et al. Anastomotic leak and stricture after hand-sewn versus linear-stapled intrathoracic oesopha-gogastric anastomosis: single-centre analysis of 415 oesophagec-tomies. Eur J Cardiothorac Surg, 2016, 49(6): 1650-1659.
9. 孫振宇, 顧敏威, 趙永, 等.食管賁門癌術后胸內吻合口狹窄的臨床分析.南京醫科大學學報(自然科學版), 2010, 30(8): 1211-1213.
10. De Giacomo T, Francioni F, Venuta F, et al. Complete mechanical cervical anastomosis using a narrow gastric tube after esophagec-tomy for cancer. Eur J Cardiothorac Surg, 2004, 26(5): 881-884.
11. Blazeby JM, Conroy T, Hammerlid E, et al. Clinical and psycho-metric validation of an EORTC questionnaire module, the EORTC QLQ-OES18, to assess quality of life in patients with oesophageal cancer. Eur J Cancer, 2003, 39(10): 1384-1394.
12. 楊國明, 王會志, 董駒, 等.賁門癌、食管癌切除術后食管-胃肌瓣胃腔內瓣膜式吻合術的測壓觀察.河北醫科大學學報, 2011, 32(6): 699-700.
13. 王文憑, 陳龍奇.食管癌外科治療的現狀與展望.中國胸心血管外科臨床雜志, 2011, 18(1): 58-65.
14. Li B, Xiang J, Zhang Y, et al. Factors affecting hospital mortality in patients with esophagogastric anastomotic leak: a retrospective study. World J Surg, 2016, 40(5): 1152-1157.
15. 段紅兵, 李敏杰, 康健樂.管狀胃成形對預防食管癌切除術后胃食管反流的作用.中國胸心血管外科臨床雜志, 2010, 17(5): 417-419.
16. 臧其威, 鄭中鋒, 陳偉.食管胃高位胸頂吻合加縱膈胸膜減張覆蓋在食管癌手術中的應用.齊齊哈爾醫學院學報, 2010, 31(5): 708-709.
17. Asteriou C, Barbetakis N, Lalountas M, et al. Modified pleural tenting for prevention of anastomotic leak after ivor lewis esopha-gogastrectomy. Ann Surg Oncol, 2011, 18(13): 3737-3742.
18. 姜志良, 楊繼武, 王林, 等.經食管床吻合術后對殘余食管的壓力測定和酸堿度分析.中華胃腸外科雜志, 2008, 11(1): 32-35.
19. 趙雍凡, 王資斌, 伍佇, 等.不同平面胃食管吻合術后食管腔內24小時pH監測.中國胸心血管外科臨床雜志, 1998, 5(3): 19-20.
20. Honda M, Wakita T, Onishi Y, et al. development and validation of a disease-specific instrument to measure diet-targeted quality of life for postoperative patients with esophagogastric cancer. Ann Surg Oncol, 2015, 22 (Suppl 3): 848-854.

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