Vagal-Sparing Esophagectomy: A More Physiologic Alternative

作者：Farzaneh Banki, Rodney J. Mason, Steven R. DeMeester, Jeffrey A. Hagen, Nagammapudur S. Balaji, Peter F. Crookes, Cedric G. Bremner, Jeffrey H. Peters, Tom R. DeMeester · 发表于：Annals of Surgery · 年份：2002 · DOI：10.1097/00000658-200209000-00009 · 被引用次数：157 · 研究领域：Esophageal Cancer Research and Treatment、Esophageal and GI Pathology、Gastric Cancer Management and Outcomes

OBJECTIVE: To evaluate the function of the vagal nerves and the gastric reservoir after vagal-sparing esophagectomy. SUMMARY BACKGROUND DATA: Esophagectomy as currently performed includes division of the vagal nerves and surgical alteration of the stomach, with attendant postoperative dumping, diarrhea, reduced meal capacity, and weight loss. Vagal-sparing esophagectomy has been introduced as a technique for removal of the esophagus while preserving the vagal nerves and gastric reservoir. The procedure is touted as having a low morbidity and is applicable to patients with end-stage benign or early malignant disease. METHODS: A random sample of 15 patients at a median of 20 months after a vagal-sparing esophagectomy was compared to 23 asymptomatic normal subjects; 10 randomly selected patients, 29 months after esophagogastrectomy with colon interposition; and 10 randomly selected patients, 47 months after standard esophagectomy with gastric pull-up. Gastric mucosal acidification was tested with Congo red staining. Vagal secretory function was measured by gastric acid output and pancreatic polypeptide response to sham feeding. Vagal motor function was assessed by a technetium gastric emptying scan and a questionnaire to evaluate dumping and diarrhea. Gastric reservoir function was evaluated by measuring meal capacity and postoperative changes in body mass index. RESULTS: Vagal-sparing esophagectomy preserved the function of the vagi, as evident by an increase in gastric acid ou...