Application of Cervical Layered Manual Anastomosis for Reconstructing the Upper Alimentary Tract in Esophageal Carcinoma

Objective: To explore the clinical value of remaining integrated mediastinal pleura upon the aortic arch with tubular stomach and left cervical esophagus layered manual anastomosis for reconstruction alimentary tract in esophagectomy. Methods: 206 patients with esophageal carcinoma from January 2010 to May 2016 in our hospital were selected and divided into the two incisions group (n = 122) and three incisions group (n = 84) according to the operation methods; the study group received two incisions esophagectomy via left thoracic-cervical pathway and using tubular stomach positioned in the original esophageal bed and cervical esophagus layered anastomosis in mucosa (4-0 absorable sutures) and muscular layer (4-0 silk), while the three incisions group underwent conventional neck-chest-abdomen three incisions method and using tubular stomach and cervical esophagus circular stapler anastomosis. All patients underwent transthoracic esophagectomy using tubular stomach as esophageal substitute; the tubular stomach was pulled to left cervical region for esophagogastric anastomosis for reconstruction alimentary transit after subtotal esophagectomy. Results: There existed an obvious difference in the occurrence of anastomotic strenosis, reflux esophagitis and operative time, the time for anastomosis between the 2 group (P < 0.05) while no statistically difference in the time of postoperative hospital stay, the respiratory dysfunction after the operation, the perioperative death and the occurrence of postoperative anastomotic leakage between the 2 groups (P > 0.05). Conclusion: The remaining integrated mediastinal pleura upon the aortic arch and performing left cervical esophagus layered manual anastomosis in esophageal carcinoma is time-saving, decreases the surgical trauma, fits for physiological function and can effectively reduce the incidence of postoperative complications, so it could be used as an alternative strategy for esophageal cancer and may be used in clinical practice.