Application value of intrathoracic Kamikawa anastomosis after total laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction
10.3760/cma.j.cn115610-20240911-00414
- VernacularTitle:食管胃结合部腺癌全腹腔镜经腹-左膈肌路径近端胃联合食管下段切除胸腔内Kamikawa吻合术的应用价值
- Author:
Peng CUI
1
;
Yinhao YANG
;
Wei WEI
;
Liang ZONG
;
Dongyang SONG
;
Jie WANG
;
Qisheng CHENG
;
Xiaonan WEI
;
Bo WANG
;
Wenqing HU
Author Information
1. 长治医学院附属长治市人民医院胃肠外科 山西省恶性肿瘤（食管胃结合部癌）临床医学研究中心，长治 046099
- Publication Type:Journal Article
- Keywords:
Adenocarcinoma of esophagogastric junction;
Proximal gastrectomy;
Diges-tive tract reconstruction;
Anti-reflux procedure;
Double-flap technique
- From:
Chinese Journal of Digestive Surgery
2024;23(10):1309-1315
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods:The retros-pective and descriptive method was conducted. The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People ′s Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected. All patients were male, aged 69 years, 60 years and 66 years, respectively. Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results:(1) Operative and postoperative situations. All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach. The operation time was 5.3 hours, 5.3 hours and 4.8 hours, respectively. The digestive tract reconstruction time was 68 minutes, 62 minutes and 55 minutes, respectively. The volume of intraoperative blood loss was 80 mL, 30 mL and 100 mL, respectively. The postoperative first flatus time of 3 patients was on the third day after operation, and the first defecation time was on the postoperative fourth, sixth and third day. All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day, and no anastomotic leakage, anastomotic stenosis or contrast agent reflux occurred. The indwelling time of abdominal drainage tube was 6 days, 7 days and 6 days, respectively. The indwel-ling time of thoracic drainage tube was 3 days, 5 days and 4 days, respectively. The duration of post-operative hospital stay was 14 days, 14 days, and 16 days, respectively. (2) Postoperative complica-tions and pathological examination. Of the 3 patients, 1 patient had postoperative pleural effusion of Clavien-Dindo grade Ⅰ, and 1 patient had bilateral pleural effusion of Clavien-Dindo grade Ⅰ. The postoperative pathological examination of 3 patients showed high-moderately differentiated adeno-carcinoma, moderately differentiated adenocarcinoma and moderately differentiated adenocarcinoma, respectively. The tumor maximum diameter of 3 patients was 3.0 cm, 3.5 cm and 3.5 cm, respec-tively. The ratio of the number of lymph node metastasis to the number of lymph node dissection was 0/43, 1/34 and 6/44, respectively. Postoperative pathological staging showed stage T3N0M0, T3N1M0, T3N2M0, respectively. (3) Follow-up. There was no reflux of contrast agent or anastomotic stenosis in upper gastrointestinal imaging of the 3 positions at 3 and 12 months after operation. No reflux esophagitis of LA-B grade or above was found by electronic gastroscopy at 3 and 12 months after operation. Nutritional indicators and quality of life were good in 3 patients. No tumor recur-rence or metastasis was found in chest and abdominal computed tonography at 12 months after operation, and anti-reflux structure was found after reconstruction of digestive tract in thoracic cavity.Conclusion:Intrathoracic Kamikawa anastomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction is safe and feasible, with excellent anti-reflux effect.
