Comparison of functional end-to-end esophagojejunostomy and side-to-side esophagojejunostomy with cis-peristalsis in laparoscopic radical resection for esophageal cancer

Objective To compare the effects of functional end-to-end esophagojejunostomy (FETE method) and side-to-side esophagojejunostomy with cis-peristalsis (overlap method) on postoperative rehabilitation, anastomotic leakage, and inflammatory-oxidative stress factors in patients undergoing laparoscopic radical resection for esophageal cancer.

Methods A total of 115 patients with esophageal cancer were selected as study subjects, and were randomly divided into overlap group (n=57) and FETE group (n=58) using random number table method, and both groups underwent laparoscopic radical resection for esophageal cancer. The overlap group received the overlap method, and the FETE group received the FETE method. The surgical-related indicators, postoperative recovery indicators, incidence of anastomotic leakage, inflammatory factorsinterleukin-10 (IL-10), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), oxidative stress factorsmalondialdehyde (MDA), superoxide dismutase (SOD), pulmonary function indicatorsforced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC, and the scores of the esophageal cancer-specific quality of life questionnaire (QLQ-OES18) were compared between the two groups.

Results There was no statistically significant difference in intraoperative blood loss between the two groups (P>0.05). The FETE group had shorter operative time and intraoperative anastomosis time, and a larger number of lymph node dissection compared with the overlap group, with statistically significant differences (P < 0.05). The FETE group had earlier postoperative first flatus time, first oral intake time, and drainage tube removal time compared with the overlap group, with statistically significant differences (P < 0.05). The incidence of anastomotic leakage was 1.72% in the FETE group and 7.02% in the overlap group, with no statistically significant difference (P>0.05). One week after surgery, the serum levels of IL-10, IL-6, TNF-α and MDA in the FETE group were lower than those in the overlap group, while the serum SOD level was higher, with statistically significant differences (P < 0.05). One week after surgery, the FVC, FEV₁ and FEV₁/FVC in the FETE group were higher than those in the overlap group, with statistically significant differences (P < 0.05). Three months after surgery, the QLQ-OES18 functional domain scores in the FETE group were higher than those in the overlap group, while the symptom domain and single symptom domain scores were lower, with statistically significant differences (P < 0.05).

Conclusion Both the FETE method and the overlap method can reduce intraoperative blood loss and the incidence of anastomotic leakage when applied in laparoscopic radical resection for esophageal cancer. However, FETE method has shorter operative time, larger number of intraoperative lymph node dissections, faster postoperative recovery, and patients have less inflammatory-oxidative stress response and pulmonary function impairment, as well as higher quality of life after surgery, showing greater advantages compared with the overlap method.