O.Yu. Usenko, A.V. Sydiuk, A.S. Klimas, O.Ye. Sydiuk

POSTOPERATIVE ANASTOMOTIC COMPLICATIONS IN PATIENTS WITH MALIGNANT TUMORS OF THE ESOPHAGUS AND ESOPHAGEAL GASTRIC JUNCTION CANCER

---

About the author:	O.Yu. Usenko, A.V. Sydiuk, A.S. Klimas, O.Ye. Sydiuk
Heading	CLINICAL MEDICINE
Type of article	Scentific article
Annotation	Formation of esophagogastric anastomosis after esophagectomy, despite apparent progress, is still accompanied by the development of complications associated with anastomosis. However, information about the impact of the method of forming esophagogastric anastomosis on the effects after the esophagectomy remains controversial. The aim of the study – to provide a comparative characteristic of postoperative complications in patients after esophagectomy, depending on the method of forming the mechanical esophagogastric anastomosis. The study included 30 patients who were formed by developed and protected by the Ukrainian patents invagination mechanical esophagogastroanastomosis (study group) and 30 patients who had formed circular mechanical esophagogastroanastomosis end-to-side (comparison group) after esophagectomy. Evaluated the rate of anastomotic leakage, the frequency of benign strictures, the frequency and severity of reflux esophagitis. In the dynamics all patients performed esophagogastroduodenoscopy, the severity of the reflux esophagitis was evaluated according to the modified Los Angeles classification. Statistical analysis of data was carried out using the statistical analysis package EZR v. 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan), Graphic interface to R (The R Foundation for Statistical Computing, Vienna, Austria). In the conditions of the formation of invagination mechanical esophagogastroanastomosis, the results revealed a statistically significant reduction in benign strictures (p=0,047) (17% (95% CІ 5,4% – 32,6%), vs 43% (95% CІ 25,7% – 61,9%), RF=0,4 (95% CІ 0,2 – 0,9), as well as the frequency of postreaction reflux esophagitis (43% vs 68%; p=0,02) in comparison with the circular mechanical esophagogastroanastomosis end-to-side. However, there were no significant differences between the two groups regarding the anastomotic leakage (0% vs 7%, p=0,49). It should be noted that in the conditions of the formation of invagination mechanical esophagogastroanastomosis cases of its leakage were not revealed. The method of formation of the invagination mechanical esophagogastroanastomosis contributes to the reduction of the frequency of benign strictures of anastomosis and reflux esophagitis, anastomotic leakage was not observed.
Tags	mechanical anastomosis, invagination, circulatory, anastomotic leakage, benign stricture, reflux esophagitis
Bibliography	Bogopolskiy PM, Balalyikin DA, Chernousov FA. K istorii razrabotki i primeneniya sshivayuschih apparatov v hirurgii pischevoda v Rossii. Vestnik hirurgicheskoy gastroenterologii. 2012; 1: 66-71. [in Russian] Hurianov VH, Liakh YuYe, Parii VD, Korotkyi OV, Chalyi OV, Chalyi KO, Tsekhmister YaV. Posibnyk z Biostatystyky. Analiz rezultativ medychnykh doslidzhen u paketi EZR (R–statistics): Navchalnyi posibnyk. Kyiv: Vistka. 2018. [in Ukrainian] Samoylov PV, Kagan II, Tretyakov AA. Mikrohirurgicheskie pischevodno-zheludochnyie anastomozyi pri rezektsii pischevoda i kardii zheludka. Annalyi hirurgii. 2014; 1: 38-44. [in Russian] Usenko OU, Sidyuk AV, KlimasAS. Sposib vykonannia ezofahoektomii. Patent Ukrainy №107325. 2016. [in Ukrainian] Booka E, Takeuchi H, Nishi T, Matsuda S, Kaburagi T, Fukuda K, … Kitagawa Y. The Impact of Postoperative Complications on Survivals After Esophagectomy for Esophageal Cancer. Medicine. 2015; 94(33): е1369. Fumagalli U, Baiocchi GL, Portolani N, Celotti A, de Pascale S, Parise P, … Reddavid R. Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks. World J. Gastroenterol. 2019; 25(3): 356-366. Honda M, Kuriyama A, Noma H, Nunobe S, Furukawa TA. Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann. Surg. 2013; 257(2): 238-248. Kikuchi H, Takeuchi H. Future Perspectives of Surgery for Esophageal Cancer. Ann Thorac Cardiovasc Surg. 2018; 24(5): 219-222. Lagergren J, Smyth E, Cunningham D, Lagergren P. Oesophageal cancer. Lancet. 2017; 390(10110): 2383-2396. Liu QX, Min JX, Deng XF, Dai JG. Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A meta-analysis. World J. Gastroenterol. 2014; 20(45): 17218-17226. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Wijnhoven BPL. Benchmarking Complications Associated with Esophagectomy. Ann Surg. 2019; 269(2): 291-298. Maas KW, Biere SS, Scheepers JJ, Gisbertz SS, Turrado Rodriguez V, van der Peet DL, Cuesta MA. Minimally invasive intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer: a review of transoral or transthoracic use of staplers. Surg. Endosc. 2012; 26(7): 1795-1802. Rasmussen SR, Nielsen RV, Fenger AS, Siemsen M., Ravn HB. Postoperative complications and survival after surgical resection of esophageal squamous cell carcinoma. J. Thorac. Dis. 2018; 10(7): 4052-4060. Xuefei Z, Qian Y, Hui T, Desheng Lv. Meta-analysis of stapled versus hand-sewn esophagogastric anastomosis. Int. J. Clin. Exp. Med. 2018; 11(11): 11606-11618. Zhou D, Liu QX, Deng XF, Min JX, Dai JG. Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: a meta-analysis. Journal of Cardiothoracic Surgery. 2015; 10: 67.
Publication of the article	«World of Medicine and Biology» №2(68), 2019 year, 135-140 pages, index UDK 616.329-089
DOI	10.26724/2079-8334-2019-2-68-135-140