Short-term efficacy of π-shaped esophageal jejunostomy in total laparoscopic radical resection of cardiac cancer and its effect on traumatic stress

Abstract

Abstract Purpose To analyze the clinical efficacy of total laparoscopic π-shaped esophageal jejunostomy and laparoscopic assisted Roux en-Y esophago-jejunostomy for cardiac cancer and their effects on traumatic stress. Methods We collected clinical data from 72 patients with adenocarcinoma of the esophagogastric junction who were treated in our department between June 2020 and July 2022. All patients underwent laparoscopic total gastrectomy + D2 lymphadenectomy, in whom 38 patients underwent total laparoscopic total gastrectomy with π-shaped esophageal jejunostomy and 34 patients underwent laparoscopic-assisted total gastrectomy with Roux en-Y esophago-jejunostomy. The short-term therapeutic effects, safety and effects on stress response indicators of different surgical methods were analyzed. Results There were no significant differences in baseline clinical and pathological data between the two groups (P > 0.05). The mean operation duration was 201.7 ± 80.3 minutes in the total endoscopic π-shaped esophageal jejunostomy group, which was longer than 166.9 ± 26.9 minutes in the laparoscopic-assisted Roux en-Y esophago-jejunostomy group (P < 0.05). The length of the surgical incision in the total endoscopic π-shaped esophageal jejunostomy group was significantly shorter, measuring 4.6 ± 2.1 cm, compared to the Roux-en-Y anastomosis group, which had an average length of 10.4 ± 2.1 cm (P < 0.01). In terms of intraoperative bleeding, the intraoperative bleeding volume of 130.3 ± 50.3 ml in the total endoscopic π-shaped esophageal jejunostomy group was significantly lower than that of 167.2 ± 72.8 ml in the laparoscopic-assisted Roux en-Y esophago-jejunostomy group (P < 0.05). Postoperative recovery time to exhaust was 3.8 ± 1.2 days in total endoscopic π-shaped esophageal jejunostomy group, significantly lower than 5.0 ± 2.0 days in laparoscopic-assisted Roux en-Y esophago-jejunostomy group (P = 0.003). In terms of postoperative extubation time, postoperative hospital stay, postoperative complications and the number of dissected lymph nodes, there were no significant differences between the total endoscopic π-shaped esophageal jejunostomy group and the laparoscopic-assisted Roux en-Y esophago-jejunostomy group (P > 0.05). In terms of stress indicators, there were no significant differences in stress indicators between the two groups before surgery, and the serum levels of CRP, cortisol (COR) and IL-6 in the π anastomosis group were significantly lower than those in the Roux en-Y esophago-jejunostomy group on postoperative days 3 and 5 (P < 0.05). Conclusion Total laparoscopic total gastrectomy with π-shaped esophageal jejunostomy demonstrates safety and feasibility. This surgical approach effectively reduces intraoperative bleeding, accelerates patient recovery time, minimizes postoperative pain, lowers the risk of complications, and minimally impacts the body's traumatic stress response.