A new three-layer-funnel-shaped esophagogastric anastomosis for surgical treatment of esophageal carcinoma

AIM: To reduce the incidence of postoperative anastomoticleak, stenosis, gastroesophageal reflux (GER) for patientswith esophageal carcinoma, and to evaluate the conventionalmethod of esophagectomy and esophagogastroplastymodified by a new three-layer-funnel-shaped (TLF)esophagogastric anastomotic suturing technique.METHODS: From January 1997 to October 1999, patientswith clinical stage Ⅰ and Ⅱ (Ⅱa and Ⅱb) esophagealcarcinoma, which met the enrollment criteria, were surgicallytreated by the new method (Group A) and by conventionaloperation (Group B). All the patients were followed at leastfor 6 months. Postoperative outcomes and complicationswere recorded and compared with the conventional methodin the same hospitals and with that reported previously byMcLarty etalin 1997 (Group C).RESULTS: 58 cases with stage Ⅰ and Ⅱ (Ⅱa and Ⅱb)esophageal carcinoma, including 38 males and 20 femalesaged from 34 to 78 (mean age: 57), were surgically treatedby the TLF anastomosis and 64 by conventional method inour hospitals from January 1997 to October 1999. The qualityof swallowing was improved significantly (Wilcoxon W＝2 142,P＝0.0 001) 2 to 3 months after the new operation in GroupA. Only one patient had a blind anastomatic fistula diagnosedby barium swallow test 2 months but healed up 3 weekslater. Postoperative complications occurred in 25 (43 %)patients, anastomotic stenosis in 8 (14 %), and GER in 13(22 %). The incidences of postoperative anastomotic leak,stenosis and GER were significantly decreased by the TLFanastomosis method compared with that of conventionalmethods (x2＝6.566, P ＝0.038; x2＝10.214, P＝ 0.006;x2＝21.265, P＝0.000).CONCLUSION: The new three-layer-funnel-shapedesophagogastric anastomosis (TLFEGA) hasmore advantagesto reduce postoperative complications of anastomotic leak,stricture and GER.

A novel method for preparation of tissue microarray

AIM:To improve the technique of tissue microarray (tissue chip).METHODS: A new tissue microarraying method was invented with a common microscope installed with a special holing needle, a sampling needle, and a special box fixing paraffin blocks on the microscope slide carrier. With the movement of microscope tube and objective stage on vertical and cross dimensions respectively, the holing procedure on the recipient paraffin blocks and sampling procedure of core tissue biopsies taken from the donor blocks were performed with the refitted microscope on the same platform.The precise observation and localization of representative regions in the donor blocks were also performed with the microscope equipped with a stereoscope.RESULTS: Highly-qualified tissue chips of colorectal tumors were produced by a new method, which simplified the conventional microarraying procedure, and was more convenient and accurate than that employing the existing tissue microarraying instruments.CONCLUSION:Using the refitted common microscope to produce tissue microarray is a simple, reliable, cost-effective and well-applicable technique.