Effect of severed right gastric artery on postoperative anastomosis after Mckeown surgery for esophageal carcinoma: A Randomized controlled trial

Effect of severed right gastric artery on postoperative anastomosis after Mckeown surgery for esophageal carcinoma: A Randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of severed right gastric artery on postoperative anastomosis after Mckeown surgery for esophageal carcinoma: A Randomized controlled trial Guibin Zhang, Shuhui Gao, Qifan Yin, peng Qie, Yongbin Song, Huien Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4907093/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the effect of right gastric artery on anastomotic fistula and anastomotic stenosis after Mckeown surgery for esophageal carcinoma. Methods Prospective analysis of 120 esophageal cancer resection from July 2018 to July 2020 In all cases, esophagogastric and neck anastomosis was performed and randomly divided into 60 cases in the right gastric artery sparing group (Group A) and 60 cases in the right gastric artery disconnection group (Group B), and the occurrence of anastomotic fistula and stenosis in different surgical groups were analyzed. Results Postoperative anastomosis in 120 patients: there was no significant difference in the incidence of postoperative anastomotic fistula (10% / 16.7%) (P > 0.05). There were differences between the two groups in groups A and B 2 months after surgery(P 0.05). Conclusion Separation of right gastric artery has no effect on anastomotic fistula after esophageal cancer and may cause postoperative anastomotic stenosis in patients. right gastric artery esophageal cancer tube stomach anastomosis Figures Figure 1 Introduction Esophageal cancer is a malignant tumor originating from the esophageal mucosal epithelium, ranking ninth and sixth in incidence and mortality worldwide. In the field of thoracic surgery, the surgical treatment of esophageal cancer has a hundred years of history [1], but its minimally invasive surgery (minimally invasive esophagectomy, MIE) has only been widely used for more than 10 years. The reason is that esophageal cancer surgery not only involves esophageal resection but also requires digestive tract reconstruction, which has a wide anatomical area and complex operation. At present, the main surgical methods of minimally invasive surgery for esophageal cancer include 3: thoracic laparoscopy and esophageal resection (gastroesophageal neck anastomosis, McKeown MIE), thoracic laparoscopy and esophageal resection (gastroesophageal intrathoracic anastomosis, Ivor-Lewis MIE), minimally invasive resection of transperforated esophageal cancer, etc. As a substitute for the esophagus after esophagectomy, gastric [1,2] is favored by surgeons because of its rich blood supply and elasticity, and it is more consistent with the physiological state (compared to empty and colon). Studies have shown that the width of the gastric tube has no effect on the local blood supply of the anastomosis and anastomotic fistula, but the whole stomach and subwhole stomach will increase the postoperative gastric emptying disorder and pulmonary complications [3,4]. In clinical work, in order to promote gastric emptying and reduce postoperative pulmonary complications, [5]gastric tube is usually made 30-40cm along and 3cm wide along the large curved side. This structure retained the right branch of the omentum and part of the right gastric artery; but there was no literature on the influence of the right gastric artery on the gastric blood supply and anastomotic fistula. The purpose of this study evaluated the effect of the right gastric artery on cervical anastomotic fistula and anastomotic stenosis after esophageal cancer. Data and methods 1.1 General information One hundred and twenty patients admitted between July 2018 and July 2020 were included in this study. Inclusion criteria were histopathologically confirmed carcinoma of the middle upper esophagus and patients meeting enrollment criteria. Exclusion criteria were patients with stage IIIB or IV, history of previous abdominal surgery, previous chemoradiotherapy, history of previous disease (severe diabetes, cardiopulmonary insufficiency, cirrhosis, etc.), unresectable esophageal tumors, and patients who were lost to follow-up and refused follow-up. The study group consisted of 74 men and 46 women, randomly divided into two groups A and B with 60 cases; there were no statistical differences in gender, age, tumor length, pathological stage, tumor staging, and number of dissected lymph nodes (see Table 1 , 2 ); Group B fully exposed the right arteriovenous root (variation in some vessels). Pathological TNM staging was based on the 2018 edition of UICC / AJCC TNM staging. Table 1 Patient case characteristics characteristics A group B group P price Tumor length 1.9 ± 0.80 2.1 ± 0.75 0.163 age/year 55 ± 7 55 ± 5 0.868 Male: female / Example number 34/26 40/20 0.260 Operation time 251 ± 21.8 263 ± 18 0.003 Clean lymph nodes / piece 26 ± 3.3 25.9 ± 2.3 0.608 Table 2 Patient case characteristics characteristics A group B group P price Pathological stage I stage 12 8 0.607 IIA stage 24 22 IIB stage 16 22 IIIA stage 8 8 Tumor segmentation / number of cases epimere 14 18 0.409 middle piece 46 42 1.2 Surgical method The same surgeon performed Mckeown surgery for thoracic and laparoscopic esophageal cancer under the same conditions. Group A (60 patients) retained the right gastric artery, Thoracoscopic free oesophagus, anatomically related regional lymph nodes; Laparoscopic free gastric body, 3cm from the gastric omental distal end of the vascular arch, Right blood vessel preservation of the gastric omentum, From the left, short, and left side of gastric omentum, The lymph nodes such as the left gastric artery, the common hepatic artery and the celiac artery were dissected; Shaborite descending 5cm auxiliary small incision, As the starting point after issuing two branches in the right gastric artery, With GCFLGB (Johnson & Johnson) along the stomach bend length about 30-40cm, 3cm wide (Figure B), None of the patients underwent pyloric formation, Tube and gastric lift through the esophageal bed to the left neck, Oesophagogastric left cervical anastomosis was performed with IIIROWS-24-C and GCFLFB (Johnson & Johnson). Group B (60 cases) left the right gastric artery group (Figure A), the same method as the previous, the difference is between the root of the right gastric artery and the vessel. Both groups were successfully extubated, anti-infection, sputum reduction, atomization, acid suppression, nutrition and other symptomatic treatment, postoperative nasogastric tube preservation, continuous gastrointestinal decompression, and removal after gastrointestinal exhaust; intensive care for 2 days, chest film, blood and biochemistry review on the 2nd day after surgery; esophagography (universal meglumine) was reviewed on the 5th day after surgery, and discharged on the 10th day after surgery. Gastroscopy and upper gastrointestinal angiography were performed to observe postoperative anastomotic stenosis. 1.3 Diagnosis of anastomotic fistula and anastomotic stenosis after esophageal cancer Anastomotic fistula: The main clinical manifestations of cervical anastomotic fistula are cervical skin swelling, tenderness, subcutaneous emphysema and fluctuation. When the suture is opened, there can be food residue, rancid pus outflow, accompanied by or without fever. Its position is shallow and easy to find, and can be clearly diagnosed combined with clinical symptoms and signs. The clinical manifestations of intrathoracic anastomotic fistula are mainly systemic poisoning symptoms, including persistent high fever, massive cough of purulent sputum, severe chest pain, dyspnea, and intraoperative liquid pneumothorax. Some patients have toxic shock without timely diagnosis and treatment. Auxiliary examination: package effusion or liquid pneumothorax. Upper gastrointestinal angiography (generalized glutamine) was this. If the non-invasive examination fails to find the small posterior wall fistula or localized fistula is feasible chest puncture, cloudy fluid or containing food residue and gastroscopy for clear diagnosis. Astomotic stenosis: record the occurrence of anastomotic stenosis at 2 and 4 months after surgery in groups A and B. Grade I: general feeding has obstruction, but semi-liquid diet, 8-10mm wide, observation; grade: semi-liquid food has obstruction, 5-8mm wide, grade, 3-5mm wide, wide, 3mm wide or even blind for treatment. Table 3 Astomotic fistula and stenosis in two groups Example number A group B group P price Anastomotic narrow Two months after surgery 18 36 0.001 Four months after surgery 6 11 0.152 Anastomotic fistula 6 10 0.283 1.4 Statistical treatment Data were analyzed using SPSS16.0 statistical software, data were expressed as x ± s using independent sample t-test, and count data by chi-square test where P < 0.05 was considered statistically significant. Results Subject characteristics in both groups are shown in Table 1 , 2 . There was no significant difference in gender, age, tumor length, pathological stage, tumor stage and number of dissected lymph nodes between the two groups; because group B required full exposure to the right gastric arteriovenous root (variation), the operation time between the two groups was different (P = 0.003). The anastomotic fistula and anastomotic stenosis in both groups are shown in Table 3 . Group A: 6 cervical anastomotic fistula (10.0%); Group B: 10 (16.7%); there was no significant difference between the two groups (P > 0.05). The patients with anastomotic fistula in both groups recovered smoothly after symptomatic treatment including anti-infection, phlegm resolving, drainage and nutritional support. Gastroscopy and upper gastrointestinal angiography performed 2 months after surgery, group A cervical anastomotic stenosis (30%), group B 36 (60%), showed a difference between the two groups (P 0.05). Discussion For the middle and upper esophageal cancer, McKeown surgery was adopted, which achieved the complete resection of esophageal tumor, standardized regional lymph node dissection and appropriate digestive tract reconstruction. The endoscopic esophageal cancer surgery has the advantages of less trauma, less bleeding, quick postoperative recovery and less postoperative complications. The causes of anastomotic fistula include: (1) anastomotic technical problems: for example, when beginners perform surgery, the chance of anastomotic fistula may increase due to unskilled technology.(2) Device problems: if the stapler nail problems may also cause anastomotic fistula.(3) Local infection: there may be contamination around the anastomosis, and localized infection foci appear after surgery. The infection focus tends to the weak side, and sometimes it can be penetrated into the gastric cavity through the anastomosis, leading to anastomotic fistula.(4) Anchotic tension: some patients' stomach is relatively small, tension when anastomosis, tension is too large, it is difficult to heal.(5) Poor blood transport: when the stomach is lifted, most of the stomach needs to be ligated to supply blood vessels, resulting in insufficient blood transport, and the anastomosis is not easy to heal in the condition of ischemia and hypoxia.(6) Patient's own factors: such as older age, preoperative malnutrition, hypoproteinemia, diabetes, etc., are the causes of poor healing. Astomotic fistula is one of the fatal complications after esophageal cancer, and once it occurs, its mortality is high. The fistula may lead to leakage of digestive fluid, causing thoracic or abdominal infection, which can be life-threatening when severe. In addition, anastomotic fistula can also affect the postoperative recovery and increase the hospital stay and treatment costs. The causes of anastomotic stenosis after esophageal cancer include: (1) uneven alignment of anastomotic mucosa: poor occlusion of mucosal layer during anastomosis, which may lead to the formation of scar after healing and cause stenosis.(2) Hypergrowth of granulation: hyperplasia of granulation tissue at the anastomosis may also lead to stenosis.(3) Postoperative infection: Postoperative infection may lead to inflammation and edema of the tissue surrounding the anastomosis, and then form a scar and cause stenosis.(4) Thick tissue layer in the anastomotic area: the tissue layer is too thick in the anastomosis, and the scar is large after healing, which may also lead to stenosis.(5) Tumor recurrence: some patients may have tumor recurrence after surgery, and the tumor tissue may grow at the anastomosis site, leading to stenosis. Anstomotic stenosis can seriously affect the patient's feeding function, leading to dysphagia, eating disorders, and even inability to eat. Long-term eating difficulties will lead to malnutrition, wasting, weight loss, seriously affecting the quality of life and survival of patients. In addition, anastomotic stenosis may cause other complications, such as reflux esophagitis and pulmonary infection. Breaking the right gastric artery has a specific implementation value in certain medical procedures, including: (1) reducing intraoperative bleeding. In some procedures, such as laparoscopic pancreaticoduodenectomy, first separating the right gastric artery can reduce the arterial blood supply to the pancreatic head and neck, thus reducing the risk of bleeding during the procedure. This is because the right gastric artery is one of the important blood feeding arteries of the head and neck of the pancreas, and it can significantly reduce the blood flow in this area after disconnection, making the surgical operation more clear and safe. By reducing intraoperative bleeding, the amount of blood transfusion can be further reduced, thus reducing the risk of infection, allergies and other blood transfusion, and helping the patient recover after surgery.(2) Optimize the surgical visual field. After leaving the right gastric artery is severed, the blood supply to the pancreatic head and neck is reduced, making the surgical vision clearer and facilitating the doctor to perform more refined operations. This is essential for the success of complex surgical procedures. A clear surgical field helps doctors to locate and handle the lesion site faster, thus shortening the operation time and reducing the surgical risk.(3) Improve the surgical success rate and patient prognosis. The surgical method of preferential arterial resection helps to achieve total pancreatic mesangial resection, which can significantly improve the R0 resection rate (i. e., complete tumor resection rate). This is important for improving patient outcomes. With a more thorough lymph node dissection and more precise surgical resection, the risk of postoperative local recurrence can be reduced, thus improving long-term patient survival. Due to the low intraoperative blood loss, short operation time and small surgical trauma, the postoperative recovery time is usually relatively short. In recent years, we routinely used Mckeown surgery for middle and upper esophageal cancer. This operation can clean the lymph nodes of two or three fields, and it is faster and less traumatic than the traditional thoracotomy surgery, which has become the standard operation method. This operation often produces tube stomach and left neck anastomosis, which is bound to have neck anastomosis related problems (anastomosis method, large tension, blood deviation, etc.), resulting to anastomotic fistula and anastomotic stenosis; how to minimize the above complications has become a problem for thoracic surgeons. This prospective randomized study showed that the analysis of postoperative anastomosis in 120 patients: no significant difference in the incidence of postoperative anastomotic fistula (10% / 16.7%) between groups A and B (P > 0.05). There were differences between the two groups in anastomotic stenosis in groups A and B (P 0.05). Pieri, et al. [6] injected contrast agent into the feeding artery to detect the vascularization of the three esophageal substitutes (whole stomach, subtotal stomach, narrow tube stomach); according to its study, the right artery of gastric omenum was the only feeding artery, and the narrow tube stomach was poorly vascularized at the anastomosis. However, PanH, Zhang R, LiA et al [3,4] studied 30 cadavers and showed that the right gastroomental artery was the main donor of the large curved lateral gastric tube, and the contribution of the right gastric artery was negligible. Yoichi Tabira et al [5] showed that the subwhole stomach has the right gastroomental vessel and the right gastric vessel, but the tissue blood flow at the anatomical site is equal to the narrow tube stomach, and only the right gastroomental artery provides blood supply. This contrasts with the Patel P H [6] The results are consistent with those of et al. Janssen H J B et al [7,8] measured the blood flow of the gastric tissue and reported leakage in 100 patients with less than 10 mL/min. These results suggest that blood flow at the anastomotic site may be the main predictor of leakage. However, they did not describe the diameter of the tube stomach and chose three different co-reconstruction routes (posterior mediastinum, retrosternal, and subcutaneous), and these factors may have influenced their results. Charalabopoulos A [9] The results showed that the right gastric artery had no effect on the blood flow in the gastric tube, while the right gastric mesh artery was an important source. As reported by [10], the BMI decreased at 6 months, remained at the same level for 12 months after surgery, decreased food intake at 6 months, and increased slightly in 12 months after surgery, and the postoperative nutritional status was no different. And Hosogi H et al [11,12] The tube stomach was compared to the whole stomach and concluded that the whole stomach was superior to the narrow gastric tube due to the slightly increased capacity and maintenance of the gastric submucosal vascular network. This finding differs from our results due to the type of replacement (whole stomach or subwhole, gastric tube or elongated gastric tube) and the path of reconstruction. In addition, the application of total gastric esophagus has a high probability of gastric emptying disorder after surgery, and the paragastric lymph nodes should be dissected along the small bend side during the operation, so we do not use the whole stomach as an esophageal substitute [13,14] . On the other hand, an intraoperative vagal denervation was observed. Gaic outlet obstruction after gastric replacement, due to the effect of delayed gastric emptying on postoperative nutritional status Kubo N et al [15] study showed that preoperative embolization of the right gastric artery, gastric short and left artery of gastric membrane, left gastric neck anastomosis will reduce the incidence of anastomotic fistula; however, this study will extend the perioperative period. Based on the above analysis, the blood supply to the right half of the stomach and the vicinity of the right gastric artery. This may lead to blood transport disorders in the anastomotic region and thus affect the healing of the anastomosis. Anastomotic ischemia is one of the main causes of anastomotic fistula after esophageal cancer [16] . When the right gastric artery is severed, if the other collateral circulation is not fully established, the anastomotic area may heal poorly by ischemia, leading to the anastomotic fistula [17] . In some cases, doctors may need to reconstruct the digestive tract and reduce the tension of the anastomosis. However, when the right gastric artery is severed, the blood supply to this part of the gastric tissue may be affected, thus reducing its compliance during the anastomosis and then increasing the tension of the anastomosis [18] . Astomotic ischemia not only affects the healing process but may also increase the risk of infection. Because ischemic tissue is more susceptible to pathogens such as bacteria, which triggers infection around the anastomosis [19] 。 This study is a single-center trial, and the number of patients included is small, so the statistical analysis may not be sufficient to give differential results, which requires further demonstration by a multi-center large sample study. Conclusion Separation of right gastric artery has no effect on anastomotic fistula after esophageal cancer, which may cause postoperative anastomotic stenosis in patients. Declarations Acknowledgements Thanks to Professor Yongbin Song and Professor Huien Wang for their careful and delicate surgical operation, the clinical trial can be carried out. Thank the thoracic surgery colleagues for their support. Author contributions Yongbin Song conceived the study. QIfan Yin collected the data, Shuhui Gao analysed the data and performed statistical analyses. Guibin Zhang drafted the manuscript. Huien WANG and Peng Qie gave important intellectual contribution and critically revised the manuscript. All authors read and approved the fnal manuscript. Funding Scientific Research Fund Project of Hebei Provincial Health Department. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study conforms to the ethical guidelines in a priori approval by the local Ethical Committee of the Hebei General Hospital. Our research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki and approved by Ethical Committee of the Hebei General Hospital with approval number (20200507). All enrolled patients signed informed consent. Consent for publication Our research obtained the consent of patients or patients’ carer for publication. Competing interests The authors declare no competing interests. Author details 1 Thoracic Surgery, Hebei General Hospital, No 348,West He-Ping Road, Xinhua District, Shijiazhuang 050000, Hebei Province, China. 2. Department of Respiratory Medicine, Hebei General Hospital, No 348,West He-Ping Road, Xinhua District, Shijiazhuang 050000, Hebei Province, China. References Li K K, Wang Y J, Zhang T M, et al.Right gastroepiploic artery length determined anastomotic leakage after minimally invasive esophagectomy for esophageal cancer: a prospective cohort study[J].International Journal of Surgery, 2024, 110(5): 2757-2764. Qureshi S, Khan S, Waseem H F, et al.Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: An experience from a low middle-income country[J].Asian Journal of Surgery, 2024, 47(1): 425-432. Pan H, Zhang R, Li A, et al.Laparoscopic gastric dissociation using a two-port approach in minimally invasive esophagectomy[J].World Journal of Surgical Oncology, 2022, 20(1): 375. Yoichi Tabira, Tomonori Sakaguchi, Hiroshi Kuhara, Kenichi Teshima,et al.The width of a gastric tube has no impact on outcome after esophagectomy[J].The American Journal of Surgery 187 (2004) 417–421. Yoichi Tabir, et al.Laparoscopic gastric dissociation using a two-port approach in minimally invasive esophagectomy[J].World Journal of Surgical Oncology, 2022, 20(1): 375. Patel P H, Patel N M, Doyle J P, et al.Circumferential resection margin rates in esophageal cancer resection-oncological equivalency and comparable clinical outcomes between open versus minimally invasive techniques: A retrospective cohort study[J].International Journal of Surgery, 2024: 10.1097. Janssen H J B, Nieuwenhuijzen G A P, Luyer M D P.Minimally invasive Ivor-Lewis esophagectomy with linear stapled side-to-side anastomosis[J].Annals of Esophagus, 2022, 5. Ikeda Y, Niimi M, Kan S, et al.Clinical significance of tissue blood flow during esophagectomy by laser Doppler flowmetry[J].Thorac Cardiovasc Surg 2001;122:1101– 1106. Charalabopoulos A, Davakis S, Sakarellos P, et al.Impact of Minimally Invasive Intrathoracic Hand-sewn Esophago-gastric Anastomosis in Esophagectomy for Cancer[J].Anticancer Research, 2023, 43(6): 2749-2755. Kou H W, Huang P C, Cheong C F, et al.Restoring the perfusion of accidentally transected right gastroepiploic vessels during gastric conduit harvest for esophagectomy using microvascular anastomosis: a case report and literature review[J].BMC surgery, 2022, 22(1): 292. Hosogi H, Sakaguchi M, Yagi D, et al.Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction[J].Langenbeck's Arch ives of Surgery, 2022: 1-9. Julien Ghelfi, Pierre-Yves Brichon, Julien Frandon, Bastien Boussat, et al.Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience[J].Cardiovasc Intervent Radiol (2016).DOI 10.1007/s 00270-016-1556-2 Francischetto T, Pinheiro V P S F, Viana E F, et al.Early postoperative outcomes of the esophagectomy minimally invasive in esophageal cancer[J].ABCD.Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2023, 36: e1743. A.K.Yetasook, D.Leung, J.A.Howington, M.S.Talamonti, et al.Laparoscopic ischemic conditioning of the stomach prior to esophagectomy[J].Diseases of the Esophagus (2012).DOI: 10.1111/j.1442-2050.2012.01374.x Kubo N, Sakurai K, Tamamori Y, et al.Jejunal Mesentery Preservation Reduces Leakage at Esophagojejunostomy After Minimally Invasive Total Gastrectomy for Gastric Cancer: a Propensity Score–Matched Cohort Study[J].Journal of Gastrointestinal Surgery, 2022, 26(12): 2460-2469. Mao Y, Gao S, Li Y, et al.Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study[J].Journal of the National Cancer Center, 2023, 3(2): 106-114. Contemporary Management of Esophageal and Gastric Cancer, An Issue of Surgical Oncology Clinics of North America, E-Book: Contemporary Management of Esophageal and Gastric Cancer, An Issue of Surgical Oncology Clinics of North America, E-Book[M].Elsevier Health Sciences, 2024. Hirata K, Yagi S, Yamada K, et al.Esophageal replacement with pedunculated gastric conduit interposition and duodenal transection for refractory anastomotic leakage after esophagectomy[J].General Thoracic and Cardiovascular Surgery Cases, 2023, 2(1): 72. Peng H, Liu Y Y, Aimudula M, et al.A safe and effective anastomotic technique for robot‐assisted minimally invasive oesophagectomy: Reverse‐puncture anastomosis[J].The International Journal of Medical Robotics and Computer Assisted Surgery, 2022, 18(1): e2336. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4907093","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":348108578,"identity":"908cb79e-2676-472e-a11d-e428d44b35c1","order_by":0,"name":"Guibin Zhang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Guibin","middleName":"","lastName":"Zhang","suffix":""},{"id":348108579,"identity":"dbb0addf-6ada-446f-945d-610c54b976dc","order_by":1,"name":"Shuhui Gao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYJACZgaGAwxs7M3Hf3wwsLEjQQvPsQTJGQVpycRrYZDIMZDm+XCIsYGQcnn3w4c/F7bdSeyTSDAwtjE4wMzAfvjoBnxaDM+kpUnPbHuW2MbzICE5x+AOHwNPWtoNvFoacsyYedsOJ7axJxw4nGPwjJlBgscMv5b+N8afwVoYEhubLQwOMzYQ0iIP8jVYC0cyMzMDMVoMJJ6lSfOcO2zcxnOMjbHHIC2ZjZBf5PuTD3/mKTssO7+9/xvDjz82dvzsh4/ht+UAuggbPuVgWxoIqRgFo2AUjIJRAAAF9E0xQVtkFAAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Shuhui","middleName":"","lastName":"Gao","suffix":""},{"id":348108580,"identity":"f192019d-170a-419d-bb90-5e23bdc40021","order_by":2,"name":"Qifan Yin","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Qifan","middleName":"","lastName":"Yin","suffix":""},{"id":348108581,"identity":"e9e9c9a1-62f1-4535-b3e2-c7e5d2d9372d","order_by":3,"name":"peng Qie","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"peng","middleName":"","lastName":"Qie","suffix":""},{"id":348108582,"identity":"76755dad-6b0d-4c66-9c15-95e082d5c88b","order_by":4,"name":"Yongbin Song","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yongbin","middleName":"","lastName":"Song","suffix":""},{"id":348108583,"identity":"62cf79c1-0041-4b56-8846-bbf9ca868478","order_by":5,"name":"Huien Wang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Huien","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-08-13 12:37:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4907093/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4907093/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66563940,"identity":"343a842c-40b8-4ce6-8cc7-e1419d819053","added_by":"auto","created_at":"2024-10-14 10:30:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":126798,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4907093/v1/b7e7efc79a22fe855d6e7855.png"},{"id":66566057,"identity":"b4218b21-8034-4e9f-bbd0-843a99ef05ed","added_by":"auto","created_at":"2024-10-14 10:46:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":498555,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4907093/v1/e07bc2f2-7ace-4287-8a8c-a180a013fa0b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of severed right gastric artery on postoperative anastomosis after Mckeown surgery for esophageal carcinoma: A Randomized controlled trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEsophageal cancer is a malignant tumor originating from the esophageal mucosal epithelium, ranking ninth and sixth in incidence and mortality worldwide. In the field of thoracic surgery, the surgical treatment of esophageal cancer has a hundred years of history [1], but its minimally invasive surgery (minimally invasive esophagectomy, MIE) has only been widely used for more than 10 years. The reason is that esophageal cancer surgery not only involves esophageal resection but also requires digestive tract reconstruction, which has a wide anatomical area and complex operation. At present, the main surgical methods of minimally invasive surgery for esophageal cancer include 3: thoracic laparoscopy and esophageal resection (gastroesophageal neck anastomosis, McKeown MIE), thoracic laparoscopy and esophageal resection (gastroesophageal intrathoracic anastomosis, Ivor-Lewis MIE), minimally invasive resection of transperforated esophageal cancer, etc. As a substitute for the esophagus after esophagectomy, gastric [1,2] is favored by surgeons because of its rich blood supply and elasticity, and it is more consistent with the physiological state (compared to empty and colon). Studies have shown that the width of the gastric tube has no effect on the local blood supply of the anastomosis and anastomotic fistula, but the whole stomach and subwhole stomach will increase the postoperative gastric emptying disorder and pulmonary complications [3,4]. In clinical work, in order to promote gastric emptying and reduce postoperative pulmonary complications, [5]gastric tube is usually made 30-40cm along and 3cm wide along the large curved side. This structure retained the right branch of the omentum and part of the right gastric artery; but there was no literature on the influence of the right gastric artery on the gastric blood supply and anastomotic fistula. The purpose of this study evaluated the effect of the right gastric artery on cervical anastomotic fistula and anastomotic stenosis after esophageal cancer.\u003c/p\u003e"},{"header":"Data and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 General information\u003c/h2\u003e \u003cp\u003eOne hundred and twenty patients admitted between July 2018 and July 2020 were included in this study. Inclusion criteria were histopathologically confirmed carcinoma of the middle upper esophagus and patients meeting enrollment criteria. Exclusion criteria were patients with stage IIIB or IV, history of previous abdominal surgery, previous chemoradiotherapy, history of previous disease (severe diabetes, cardiopulmonary insufficiency, cirrhosis, etc.), unresectable esophageal tumors, and patients who were lost to follow-up and refused follow-up. The study group consisted of 74 men and 46 women, randomly divided into two groups A and B with 60 cases; there were no statistical differences in gender, age, tumor length, pathological stage, tumor staging, and number of dissected lymph nodes (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e); Group B fully exposed the right arteriovenous root (variation in some vessels). Pathological TNM staging was based on the 2018 edition of UICC / AJCC TNM staging.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient case characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP price\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor length\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage/year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.868\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale: female /\u003c/p\u003e \u003cp\u003eExample number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34/26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40/20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251\u0026thinsp;\u0026plusmn;\u0026thinsp;21.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClean lymph nodes / piece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient case characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP price\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePathological stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIIA stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIIB stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIIIA stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor segmentation / number of cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eepimere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emiddle piece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Surgical method\u003c/h3\u003e\n\u003cp\u003eThe same surgeon performed Mckeown surgery for thoracic and laparoscopic esophageal cancer under the same conditions.\u003c/p\u003e \u003cp\u003eGroup A (60 patients) retained the right gastric artery, Thoracoscopic free oesophagus, anatomically related regional lymph nodes; Laparoscopic free gastric body, 3cm from the gastric omental distal end of the vascular arch, Right blood vessel preservation of the gastric omentum, From the left, short, and left side of gastric omentum, The lymph nodes such as the left gastric artery, the common hepatic artery and the celiac artery were dissected; Shaborite descending 5cm auxiliary small incision, As the starting point after issuing two branches in the right gastric artery, With GCFLGB (Johnson \u0026amp; Johnson) along the stomach bend length about 30-40cm, 3cm wide (Figure B), None of the patients underwent pyloric formation, Tube and gastric lift through the esophageal bed to the left neck, Oesophagogastric left cervical anastomosis was performed with IIIROWS-24-C and GCFLFB (Johnson \u0026amp; Johnson).\u003c/p\u003e \u003cp\u003eGroup B (60 cases) left the right gastric artery group (Figure A), the same method as the previous, the difference is between the root of the right gastric artery and the vessel.\u003c/p\u003e \u003cp\u003e Both groups were successfully extubated, anti-infection, sputum reduction, atomization, acid suppression, nutrition and other symptomatic treatment, postoperative nasogastric tube preservation, continuous gastrointestinal decompression, and removal after gastrointestinal exhaust; intensive care for 2 days, chest film, blood and biochemistry review on the 2nd day after surgery; esophagography (universal meglumine) was reviewed on the 5th day after surgery, and discharged on the 10th day after surgery. Gastroscopy and upper gastrointestinal angiography were performed to observe postoperative anastomotic stenosis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003e1.3 Diagnosis of anastomotic fistula and anastomotic stenosis after esophageal cancer\u003c/h3\u003e\n\u003cp\u003eAnastomotic fistula: The main clinical manifestations of cervical anastomotic fistula are cervical skin swelling, tenderness, subcutaneous emphysema and fluctuation. When the suture is opened, there can be food residue, rancid pus outflow, accompanied by or without fever. Its position is shallow and easy to find, and can be clearly diagnosed combined with clinical symptoms and signs. The clinical manifestations of intrathoracic anastomotic fistula are mainly systemic poisoning symptoms, including persistent high fever, massive cough of purulent sputum, severe chest pain, dyspnea, and intraoperative liquid pneumothorax. Some patients have toxic shock without timely diagnosis and treatment. Auxiliary examination: package effusion or liquid pneumothorax. Upper gastrointestinal angiography (generalized glutamine) was this. If the non-invasive examination fails to find the small posterior wall fistula or localized fistula is feasible chest puncture, cloudy fluid or containing food residue and gastroscopy for clear diagnosis.\u003c/p\u003e \u003cp\u003eAstomotic stenosis: record the occurrence of anastomotic stenosis at 2 and 4 months after surgery in groups A and B. Grade I: general feeding has obstruction, but semi-liquid diet, 8-10mm wide, observation; grade: semi-liquid food has obstruction, 5-8mm wide, grade, 3-5mm wide, wide, 3mm wide or even blind for treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAstomotic fistula and stenosis in two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExample number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP price\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnastomotic narrow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnastomotic fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003e1.4 Statistical treatment\u003c/h3\u003e\n\u003cp\u003eData were analyzed using SPSS16.0 statistical software, data were expressed as x\u0026thinsp;\u0026plusmn;\u0026thinsp;s using independent sample t-test, and count data by chi-square test where P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSubject characteristics in both groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There was no significant difference in gender, age, tumor length, pathological stage, tumor stage and number of dissected lymph nodes between the two groups; because group B required full exposure to the right gastric arteriovenous root (variation), the operation time between the two groups was different (P\u0026thinsp;=\u0026thinsp;0.003). The anastomotic fistula and anastomotic stenosis in both groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Group A: 6 cervical anastomotic fistula (10.0%); Group B: 10 (16.7%); there was no significant difference between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The patients with anastomotic fistula in both groups recovered smoothly after symptomatic treatment including anti-infection, phlegm resolving, drainage and nutritional support. Gastroscopy and upper gastrointestinal angiography performed 2 months after surgery, group A cervical anastomotic stenosis (30%), group B 36 (60%), showed a difference between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); gastroscopy and upper gastrointestinal angiography, 6 (20%) in group A, and 11 (36.7%), showing no significant difference in anastomotic stenosis in the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFor the middle and upper esophageal cancer, McKeown surgery was adopted, which achieved the complete resection of esophageal tumor, standardized regional lymph node dissection and appropriate digestive tract reconstruction. The endoscopic esophageal cancer surgery has the advantages of less trauma, less bleeding, quick postoperative recovery and less postoperative complications. The causes of anastomotic fistula include: (1) anastomotic technical problems: for example, when beginners perform surgery, the chance of anastomotic fistula may increase due to unskilled technology.(2) Device problems: if the stapler nail problems may also cause anastomotic fistula.(3) Local infection: there may be contamination around the anastomosis, and localized infection foci appear after surgery. The infection focus tends to the weak side, and sometimes it can be penetrated into the gastric cavity through the anastomosis, leading to anastomotic fistula.(4) Anchotic tension: some patients' stomach is relatively small, tension when anastomosis, tension is too large, it is difficult to heal.(5) Poor blood transport: when the stomach is lifted, most of the stomach needs to be ligated to supply blood vessels, resulting in insufficient blood transport, and the anastomosis is not easy to heal in the condition of ischemia and hypoxia.(6) Patient's own factors: such as older age, preoperative malnutrition, hypoproteinemia, diabetes, etc., are the causes of poor healing. Astomotic fistula is one of the fatal complications after esophageal cancer, and once it occurs, its mortality is high. The fistula may lead to leakage of digestive fluid, causing thoracic or abdominal infection, which can be life-threatening when severe. In addition, anastomotic fistula can also affect the postoperative recovery and increase the hospital stay and treatment costs.\u003c/p\u003e \u003cp\u003eThe causes of anastomotic stenosis after esophageal cancer include: (1) uneven alignment of anastomotic mucosa: poor occlusion of mucosal layer during anastomosis, which may lead to the formation of scar after healing and cause stenosis.(2) Hypergrowth of granulation: hyperplasia of granulation tissue at the anastomosis may also lead to stenosis.(3) Postoperative infection: Postoperative infection may lead to inflammation and edema of the tissue surrounding the anastomosis, and then form a scar and cause stenosis.(4) Thick tissue layer in the anastomotic area: the tissue layer is too thick in the anastomosis, and the scar is large after healing, which may also lead to stenosis.(5) Tumor recurrence: some patients may have tumor recurrence after surgery, and the tumor tissue may grow at the anastomosis site, leading to stenosis.\u003c/p\u003e \u003cp\u003eAnstomotic stenosis can seriously affect the patient's feeding function, leading to dysphagia, eating disorders, and even inability to eat. Long-term eating difficulties will lead to malnutrition, wasting, weight loss, seriously affecting the quality of life and survival of patients. In addition, anastomotic stenosis may cause other complications, such as reflux esophagitis and pulmonary infection.\u003c/p\u003e \u003cp\u003eBreaking the right gastric artery has a specific implementation value in certain medical procedures, including: (1) reducing intraoperative bleeding. In some procedures, such as laparoscopic pancreaticoduodenectomy, first separating the right gastric artery can reduce the arterial blood supply to the pancreatic head and neck, thus reducing the risk of bleeding during the procedure. This is because the right gastric artery is one of the important blood feeding arteries of the head and neck of the pancreas, and it can significantly reduce the blood flow in this area after disconnection, making the surgical operation more clear and safe. By reducing intraoperative bleeding, the amount of blood transfusion can be further reduced, thus reducing the risk of infection, allergies and other blood transfusion, and helping the patient recover after surgery.(2) Optimize the surgical visual field. After leaving the right gastric artery is severed, the blood supply to the pancreatic head and neck is reduced, making the surgical vision clearer and facilitating the doctor to perform more refined operations. This is essential for the success of complex surgical procedures. A clear surgical field helps doctors to locate and handle the lesion site faster, thus shortening the operation time and reducing the surgical risk.(3) Improve the surgical success rate and patient prognosis. The surgical method of preferential arterial resection helps to achieve total pancreatic mesangial resection, which can significantly improve the R0 resection rate (i. e., complete tumor resection rate). This is important for improving patient outcomes. With a more thorough lymph node dissection and more precise surgical resection, the risk of postoperative local recurrence can be reduced, thus improving long-term patient survival. Due to the low intraoperative blood loss, short operation time and small surgical trauma, the postoperative recovery time is usually relatively short.\u003c/p\u003e \u003cp\u003eIn recent years, we routinely used Mckeown surgery for middle and upper esophageal cancer. This operation can clean the lymph nodes of two or three fields, and it is faster and less traumatic than the traditional thoracotomy surgery, which has become the standard operation method. This operation often produces tube stomach and left neck anastomosis, which is bound to have neck anastomosis related problems (anastomosis method, large tension, blood deviation, etc.), resulting to anastomotic fistula and anastomotic stenosis; how to minimize the above complications has become a problem for thoracic surgeons. This prospective randomized study showed that the analysis of postoperative anastomosis in 120 patients: no significant difference in the incidence of postoperative anastomotic fistula (10% / 16.7%) between groups A and B (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There were differences between the two groups in anastomotic stenosis in groups A and B (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); no significant difference between the two groups 4 months after surgery (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Pieri, et al. [6] injected contrast agent into the feeding artery to detect the vascularization of the three esophageal substitutes (whole stomach, subtotal stomach, narrow tube stomach); according to its study, the right artery of gastric omenum was the only feeding artery, and the narrow tube stomach was poorly vascularized at the anastomosis. However, PanH, Zhang R, LiA et al [3,4] studied 30 cadavers and showed that the right gastroomental artery was the main donor of the large curved lateral gastric tube, and the contribution of the right gastric artery was negligible. Yoichi Tabira et al [5] showed that the subwhole stomach has the right gastroomental vessel and the right gastric vessel, but the tissue blood flow at the anatomical site is equal to the narrow tube stomach, and only the right gastroomental artery provides blood supply. This contrasts with the Patel P H\u003csup\u003e[6]\u003c/sup\u003eThe results are consistent with those of et al. Janssen H J B et al [7,8] measured the blood flow of the gastric tissue and reported leakage in 100 patients with less than 10 mL/min. These results suggest that blood flow at the anastomotic site may be the main predictor of leakage. However, they did not describe the diameter of the tube stomach and chose three different co-reconstruction routes (posterior mediastinum, retrosternal, and subcutaneous), and these factors may have influenced their results. Charalabopoulos A\u003csup\u003e[9]\u003c/sup\u003eThe results showed that the right gastric artery had no effect on the blood flow in the gastric tube, while the right gastric mesh artery was an important source. As reported by [10], the BMI decreased at 6 months, remained at the same level for 12 months after surgery, decreased food intake at 6 months, and increased slightly in 12 months after surgery, and the postoperative nutritional status was no different. And Hosogi H et al\u003csup\u003e[11,12]\u003c/sup\u003eThe tube stomach was compared to the whole stomach and concluded that the whole stomach was superior to the narrow gastric tube due to the slightly increased capacity and maintenance of the gastric submucosal vascular network. This finding differs from our results due to the type of replacement (whole stomach or subwhole, gastric tube or elongated gastric tube) and the path of reconstruction. In addition, the application of total gastric esophagus has a high probability of gastric emptying disorder after surgery, and the paragastric lymph nodes should be dissected along the small bend side during the operation, so we do not use the whole stomach as an esophageal substitute\u003csup\u003e[13,14]\u003c/sup\u003e. On the other hand, an intraoperative vagal denervation was observed. Gaic outlet obstruction after gastric replacement, due to the effect of delayed gastric emptying on postoperative nutritional status Kubo N et al [15] study showed that preoperative embolization of the right gastric artery, gastric short and left artery of gastric membrane, left gastric neck anastomosis will reduce the incidence of anastomotic fistula; however, this study will extend the perioperative period.\u003c/p\u003e \u003cp\u003eBased on the above analysis, the blood supply to the right half of the stomach and the vicinity of the right gastric artery. This may lead to blood transport disorders in the anastomotic region and thus affect the healing of the anastomosis. Anastomotic ischemia is one of the main causes of anastomotic fistula after esophageal cancer\u003csup\u003e[16]\u003c/sup\u003e. When the right gastric artery is severed, if the other collateral circulation is not fully established, the anastomotic area may heal poorly by ischemia, leading to the anastomotic fistula\u003csup\u003e[17]\u003c/sup\u003e. In some cases, doctors may need to reconstruct the digestive tract and reduce the tension of the anastomosis. However, when the right gastric artery is severed, the blood supply to this part of the gastric tissue may be affected, thus reducing its compliance during the anastomosis and then increasing the tension of the anastomosis\u003csup\u003e[18]\u003c/sup\u003e. Astomotic ischemia not only affects the healing process but may also increase the risk of infection. Because ischemic tissue is more susceptible to pathogens such as bacteria, which triggers infection around the anastomosis\u003csup\u003e[19]\u003c/sup\u003e。\u003c/p\u003e \u003cp\u003eThis study is a single-center trial, and the number of patients included is small, so the statistical analysis may not be sufficient to give differential results, which requires further demonstration by a multi-center large sample study.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eSeparation of right gastric artery has no effect on anastomotic fistula after esophageal cancer, which may cause postoperative anastomotic stenosis in patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThanks to Professor Yongbin Song and Professor Huien Wang for their careful and delicate surgical operation, the clinical trial can be carried out. Thank the thoracic surgery colleagues for their support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYongbin Song conceived the study. QIfan Yin collected the data, Shuhui Gao analysed the data and performed statistical analyses. Guibin Zhang drafted the manuscript. Huien WANG and Peng Qie gave important intellectual contribution and critically revised the manuscript. All authors read and approved the fnal manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScientific Research Fund Project of Hebei Provincial Health Department.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study conforms to the ethical guidelines in a priori approval by the local Ethical Committee of the Hebei General Hospital. Our research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki and approved by Ethical Committee of the Hebei General Hospital with approval number (20200507). All enrolled patients signed informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur research obtained the consent of patients or patients\u0026rsquo; carer for publication.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Thoracic Surgery, Hebei General Hospital, No 348,West He-Ping Road, Xinhua District, Shijiazhuang 050000, Hebei Province, China.\u003c/p\u003e\n\u003cp\u003e2. Department of Respiratory Medicine, Hebei General Hospital, No 348,West He-Ping Road, Xinhua District, Shijiazhuang 050000, Hebei Province, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi K K, Wang Y J, Zhang T M, et al.Right gastroepiploic artery length determined anastomotic leakage after minimally invasive esophagectomy for esophageal cancer: a prospective cohort study[J].International Journal of Surgery, 2024, 110(5): 2757-2764.\u003c/li\u003e\n\u003cli\u003eQureshi S, Khan S, Waseem H F, et al.Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: An experience from a low middle-income country[J].Asian Journal of Surgery, 2024, 47(1): 425-432.\u003c/li\u003e\n\u003cli\u003ePan H, Zhang R, Li A, et al.Laparoscopic gastric dissociation using a two-port approach in minimally invasive esophagectomy[J].World Journal of Surgical Oncology, 2022, 20(1): 375.\u003c/li\u003e\n\u003cli\u003eYoichi Tabira, Tomonori Sakaguchi, Hiroshi Kuhara, Kenichi Teshima,et al.The width of a gastric tube has no impact on outcome after esophagectomy[J].The American Journal of Surgery 187 (2004) 417–421.\u003c/li\u003e\n\u003cli\u003eYoichi Tabir, et al.Laparoscopic gastric dissociation using a two-port approach in minimally invasive esophagectomy[J].World Journal of Surgical Oncology, 2022, 20(1): 375.\u003c/li\u003e\n\u003cli\u003ePatel P H, Patel N M, Doyle J P, et al.Circumferential resection margin rates in esophageal cancer resection-oncological equivalency and comparable clinical outcomes between open versus minimally invasive techniques: A retrospective cohort study[J].International Journal of Surgery, 2024: 10.1097.\u003c/li\u003e\n\u003cli\u003eJanssen H J B, Nieuwenhuijzen G A P, Luyer M D P.Minimally invasive Ivor-Lewis esophagectomy with linear stapled side-to-side anastomosis[J].Annals of Esophagus, 2022, 5.\u003c/li\u003e\n\u003cli\u003eIkeda Y, Niimi M, Kan S, et al.Clinical significance of tissue blood flow during esophagectomy by laser Doppler flowmetry[J].Thorac Cardiovasc Surg 2001;122:1101– 1106.\u003c/li\u003e\n\u003cli\u003eCharalabopoulos A, Davakis S, Sakarellos P, et al.Impact of Minimally Invasive Intrathoracic Hand-sewn Esophago-gastric Anastomosis in Esophagectomy for Cancer[J].Anticancer Research, 2023, 43(6): 2749-2755.\u003c/li\u003e\n\u003cli\u003eKou H W, Huang P C, Cheong C F, et al.Restoring the perfusion of accidentally transected right gastroepiploic vessels during gastric conduit harvest for esophagectomy using microvascular anastomosis: a case report and literature review[J].BMC surgery, 2022, 22(1): 292.\u003c/li\u003e\n\u003cli\u003eHosogi H, Sakaguchi M, Yagi D, et al.Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction[J].Langenbeck's Arch ives of Surgery, 2022: 1-9.\u003c/li\u003e\n\u003cli\u003eJulien Ghelfi, Pierre-Yves Brichon, Julien Frandon, Bastien Boussat, et al.Ischemic Gastric Conditioning by Preoperative Arterial Embolization Before Oncologic Esophagectomy: A Single-Center Experience[J].Cardiovasc Intervent Radiol (2016).DOI 10.1007/s 00270-016-1556-2\u003c/li\u003e\n\u003cli\u003eFrancischetto T, Pinheiro V P S F, Viana E F, et al.Early postoperative outcomes of the esophagectomy minimally invasive in esophageal cancer[J].ABCD.Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2023, 36: e1743.\u003c/li\u003e\n\u003cli\u003eA.K.Yetasook, D.Leung, J.A.Howington, M.S.Talamonti, et al.Laparoscopic ischemic conditioning of the stomach prior to esophagectomy[J].Diseases of the Esophagus (2012).DOI: 10.1111/j.1442-2050.2012.01374.x\u003c/li\u003e\n\u003cli\u003eKubo N, Sakurai K, Tamamori Y, et al.Jejunal Mesentery Preservation Reduces Leakage at Esophagojejunostomy After Minimally Invasive Total Gastrectomy for Gastric Cancer: a Propensity Score–Matched Cohort Study[J].Journal of Gastrointestinal Surgery, 2022, 26(12): 2460-2469.\u003c/li\u003e\n\u003cli\u003eMao Y, Gao S, Li Y, et al.Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study[J].Journal of the National Cancer Center, 2023, 3(2): 106-114.\u003c/li\u003e\n\u003cli\u003eContemporary Management of Esophageal and Gastric Cancer, An Issue of Surgical Oncology Clinics of North America, E-Book: Contemporary Management of Esophageal and Gastric Cancer, An Issue of Surgical Oncology Clinics of North America, E-Book[M].Elsevier Health Sciences, 2024.\u003c/li\u003e\n\u003cli\u003eHirata K, Yagi S, Yamada K, et al.Esophageal replacement with pedunculated gastric conduit interposition and duodenal transection for refractory anastomotic leakage after esophagectomy[J].General Thoracic and Cardiovascular Surgery Cases, 2023, 2(1): 72.\u003c/li\u003e\n\u003cli\u003ePeng H, Liu Y Y, Aimudula M, et al.A safe and effective anastomotic technique for robot‐assisted minimally invasive oesophagectomy: Reverse‐puncture anastomosis[J].The International Journal of Medical Robotics and Computer Assisted Surgery, 2022, 18(1): e2336.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"right gastric artery, esophageal cancer, tube stomach, anastomosis","lastPublishedDoi":"10.21203/rs.3.rs-4907093/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4907093/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo evaluate the effect of right gastric artery on anastomotic fistula and anastomotic stenosis after Mckeown surgery for esophageal carcinoma.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eProspective analysis of 120 esophageal cancer resection from July 2018 to July 2020 In all cases, esophagogastric and neck anastomosis was performed and randomly divided into 60 cases in the right gastric artery sparing group (Group A) and 60 cases in the right gastric artery disconnection group (Group B), and the occurrence of anastomotic fistula and stenosis in different surgical groups were analyzed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePostoperative anastomosis in 120 patients: there was no significant difference in the incidence of postoperative anastomotic fistula (10% / 16.7%) (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There were differences between the two groups in groups A and B 2 months after surgery(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); no significant difference between the two groups 4 months after surgery (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSeparation of right gastric artery has no effect on anastomotic fistula after esophageal cancer and may cause postoperative anastomotic stenosis in patients.\u003c/p\u003e","manuscriptTitle":"Effect of severed right gastric artery on postoperative anastomosis after Mckeown surgery for esophageal carcinoma: A Randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-14 10:30:34","doi":"10.21203/rs.3.rs-4907093/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c9b8541-ca87-4a33-9bb9-74e5ad7a8d30","owner":[],"postedDate":"October 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-14T10:30:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-14 10:30:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4907093","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4907093","identity":"rs-4907093","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}