Lei Dai, Xiang Tan, Mingwu Chen, Huajian Peng, Yongyong Wang
{"title":"食管癌麦氏食管切除术中纵隔引流术联合上纵隔再隧道术与单纯纵隔引流术的对比：一项回顾性研究。","authors":"Lei Dai, Xiang Tan, Mingwu Chen, Huajian Peng, Yongyong Wang","doi":"10.3389/fsurg.2024.1436176","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although mediastinal drainage may lower the risk of anastomotic leakage, the incident rate of anastomotic leakage is still high. The current study aimed to compare the effects of mediastinal drainage combined with upper mediastinal re-tunneling with mediastinal drainage only on anastomotic leakage after McKeown esophagectomy for esophageal cancer.</p><p><strong>Methods: </strong>From October 2018 to March 2021, 52 patients diagnosed as esophageal carcinoma were included in the study. 21 patients received mediastinal drainage combined with upper mediastinal re-tunneling (re-tunneling group) and 31 received mediastinal drainage only (standard group) after McKeown esophagectomy. The incidence rate of anastomotic leakage, mediastinal infection, chylothorax, thoracic infection, the peak value of leukocyte count and the mortality related to anastomotic leakage were compared between the two groups.</p><p><strong>Results: </strong>One (4.8%) patient in the re-tunneling group developed anastomotic leakage, and no patient experienced mediastinal infection or thoracic infection. Four (12.9%) patients in the standard group developed anastomotic leakage, and all these patients experienced mediastinal infection and thoracic infection (<i>p</i> < 0.05). The drainage volumes of patients in the re-tunneling group and the standard group were (170 ± 60) ml and (155 ± 45) ml, respectively, with no significant difference between the two groups (<i>p</i> > 0.05). The peak values of leukocyte count and temperature in the re-tunneling group were (14.28 ± 1.12) × 10<sup>9</sup>/L and (38.6 ± 1.1) °C, both lower than that of the standard group[ (16.48 ± 1.15) × 10<sup>9</sup>/L and (38.9 ± 1.2) °C, respectively]. But the difference was not statistically significant (<i>p</i> > 0.05). No anastomotic leakage related death occurred in both groups.</p><p><strong>Conclusion: </strong>Mediastinal drainage combined with upper mediastinal re-tunneling after McKeown esophagectomy for esophageal cancer may decrease the risk of anastomotic leakage, mediastinal and thoracic infection, reduce the inflammatory response of patients, but did not increase the mortality related to anastomotic leakage.</p><p><strong>Trial registration: </strong>The study was retrospectively registered.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"11 ","pages":"1436176"},"PeriodicalIF":1.6000,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480071/pdf/","citationCount":"0","resultStr":"{\"title\":\"Mediastinal drainage combined with upper mediastinal re-tunneling vs. mediastinal drainage alone in McKeown esophagectomy of esophageal cancer: a retrospective study.\",\"authors\":\"Lei Dai, Xiang Tan, Mingwu Chen, Huajian Peng, Yongyong Wang\",\"doi\":\"10.3389/fsurg.2024.1436176\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although mediastinal drainage may lower the risk of anastomotic leakage, the incident rate of anastomotic leakage is still high. The current study aimed to compare the effects of mediastinal drainage combined with upper mediastinal re-tunneling with mediastinal drainage only on anastomotic leakage after McKeown esophagectomy for esophageal cancer.</p><p><strong>Methods: </strong>From October 2018 to March 2021, 52 patients diagnosed as esophageal carcinoma were included in the study. 21 patients received mediastinal drainage combined with upper mediastinal re-tunneling (re-tunneling group) and 31 received mediastinal drainage only (standard group) after McKeown esophagectomy. The incidence rate of anastomotic leakage, mediastinal infection, chylothorax, thoracic infection, the peak value of leukocyte count and the mortality related to anastomotic leakage were compared between the two groups.</p><p><strong>Results: </strong>One (4.8%) patient in the re-tunneling group developed anastomotic leakage, and no patient experienced mediastinal infection or thoracic infection. Four (12.9%) patients in the standard group developed anastomotic leakage, and all these patients experienced mediastinal infection and thoracic infection (<i>p</i> < 0.05). The drainage volumes of patients in the re-tunneling group and the standard group were (170 ± 60) ml and (155 ± 45) ml, respectively, with no significant difference between the two groups (<i>p</i> > 0.05). The peak values of leukocyte count and temperature in the re-tunneling group were (14.28 ± 1.12) × 10<sup>9</sup>/L and (38.6 ± 1.1) °C, both lower than that of the standard group[ (16.48 ± 1.15) × 10<sup>9</sup>/L and (38.9 ± 1.2) °C, respectively]. But the difference was not statistically significant (<i>p</i> > 0.05). No anastomotic leakage related death occurred in both groups.</p><p><strong>Conclusion: </strong>Mediastinal drainage combined with upper mediastinal re-tunneling after McKeown esophagectomy for esophageal cancer may decrease the risk of anastomotic leakage, mediastinal and thoracic infection, reduce the inflammatory response of patients, but did not increase the mortality related to anastomotic leakage.</p><p><strong>Trial registration: </strong>The study was retrospectively registered.</p>\",\"PeriodicalId\":12564,\"journal\":{\"name\":\"Frontiers in Surgery\",\"volume\":\"11 \",\"pages\":\"1436176\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-10-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11480071/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fsurg.2024.1436176\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2024.1436176","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Mediastinal drainage combined with upper mediastinal re-tunneling vs. mediastinal drainage alone in McKeown esophagectomy of esophageal cancer: a retrospective study.
Background: Although mediastinal drainage may lower the risk of anastomotic leakage, the incident rate of anastomotic leakage is still high. The current study aimed to compare the effects of mediastinal drainage combined with upper mediastinal re-tunneling with mediastinal drainage only on anastomotic leakage after McKeown esophagectomy for esophageal cancer.
Methods: From October 2018 to March 2021, 52 patients diagnosed as esophageal carcinoma were included in the study. 21 patients received mediastinal drainage combined with upper mediastinal re-tunneling (re-tunneling group) and 31 received mediastinal drainage only (standard group) after McKeown esophagectomy. The incidence rate of anastomotic leakage, mediastinal infection, chylothorax, thoracic infection, the peak value of leukocyte count and the mortality related to anastomotic leakage were compared between the two groups.
Results: One (4.8%) patient in the re-tunneling group developed anastomotic leakage, and no patient experienced mediastinal infection or thoracic infection. Four (12.9%) patients in the standard group developed anastomotic leakage, and all these patients experienced mediastinal infection and thoracic infection (p < 0.05). The drainage volumes of patients in the re-tunneling group and the standard group were (170 ± 60) ml and (155 ± 45) ml, respectively, with no significant difference between the two groups (p > 0.05). The peak values of leukocyte count and temperature in the re-tunneling group were (14.28 ± 1.12) × 109/L and (38.6 ± 1.1) °C, both lower than that of the standard group[ (16.48 ± 1.15) × 109/L and (38.9 ± 1.2) °C, respectively]. But the difference was not statistically significant (p > 0.05). No anastomotic leakage related death occurred in both groups.
Conclusion: Mediastinal drainage combined with upper mediastinal re-tunneling after McKeown esophagectomy for esophageal cancer may decrease the risk of anastomotic leakage, mediastinal and thoracic infection, reduce the inflammatory response of patients, but did not increase the mortality related to anastomotic leakage.
Trial registration: The study was retrospectively registered.
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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