eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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abstract:
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Covering the gastric tube with the mediastinal pleura during minimally invasive McKeown esophagectomy can reduce the incidence of anastomotic fistulae

Xiaodong Zhu
1, 2
,
Hanran Wu
2
,
Changqing Liu
2
,
Xinyu Mei
2

1.
Department of Thoracic Surgery, Anhui Provincial Hospital, Wannan Medical College, Hefei, China
2.
Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
Videosurgery Miniinv
Online publish date: 2021/04/09
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Introduction
The rate of anastomotic leakage from intrathoracic esophagogastric anastomoses can be reduced by covering them with the mediastinal pleura. Whether anastomotic leakage can be reduced by covering the portion of the gastric tube in the upper mediastinum with the mediastinal pleura during minimally invasive McKeown esophagectomy (MIE McKeown) is unknown. Aim: To evaluate the consequence of covering the mediastinal pleural during minimally invasive McKeown esophagectomy.

Material and methods
Consecutive patients who underwent MIE McKeown between January 2015 and December 2019 were retrospectively analyzed. Participants for whom the portion of the gastric tube in the upper mediastinum was not covered with the mediastinal pleura were assigned to group A; otherwise, they were assigned to group B. Chi-square analysis and univariable and multivariable logistic analyses were used to compare the differences between the two groups and explore the risk factors for anastomotic fistulae.

Results
A total of 267 patients with middle and lower esophageal cancer were included in this study (131 in group A and 136 in group B). Anastomotic leakage occurred in 5 patients (5/136) in group B compared with 13 patients (13/131) in group A (p = 0.042). Univariable and multivariable logistic analyses identified a gastric tube not covered with the mediastinal pleura as a risk factor for significantly greater anastomotic leakage (p = 0.042), but it was not an independent prognostic factor for anastomotic leakage (odds ratio = 0.585, 95% confidence interval: lower bound: 0.069, upper bound, 1.122).

Conclusions
This study provides preliminary evidence that covering the gastric tube with the mediastinal pleura during MIE McKeown can decrease the incidence of anastomotic leakage.

keywords:

covering mediastinal pleura, McKeown esophagectomy, anastomotic leakage

  
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