Short-term clinical efficacy between coniform and conventional gastric tube in inflatable mediastinoscopy combined with laparoscopic esophagectomy: a propensity score-matched retrospective cohort study

Esophageal cancer, a highly prevalent gastrointestinal malignancy in China, is primarily treated by surgical resection. Inflatable mediastinoscopy combined with laparoscopic esophagectomy has been gradually adopted in the surgical treatment for esophageal cancer. The gastric-shaping strategy for digestive tract reconstruction directly affects postoperative recovery and complication occurrence. Conventional gastric tube reconstruction is still associated with problems such as intrathoracic gastric dilatation and gastroesophageal reflux, whereas the advantages and disadvantages of the coniform gastric tube in this surgical procedure remain unclear. This study aims to compare the clinical outcomes between conventional gastric tube and coniform gastric tube reconstruction after inflatable mediastinoscopy combined with laparoscopic esophagectomy.

A single-center retrospective cohort study was conducted on 139 patients who underwent inflatable mediastinoscopy combined with laparoscopic esophagectomy in Department of Thoracic Surgery of Huaihe Hospital of Henan University between January 2023 and January 2025. According to different digestive tract reconstruction strategies, the patients were divided into a conventional gastric tube group (n=77) and a coniform gastric tube group (n=62). All patients received handsewn anastomosis. Propensity-score matching (PSM) was performed at a 1:1 ratio. The primary outcome was the incidence of postoperative complications, the secondary outcome was postoperative subjective and objective nutritional indicators, and secondary outcomes included inflammatory factors, gastrointestinal function indicators, and quality of life.

After PSM, 55 patients were included in each group, with no statistically significant differences in baseline characteristics between groups (all P>0.05). The coniform gastric tube group demonstrated significantly shorter time to first postoperative flatus [(1.16±0.96) vs (1.58± 1.20) d, P=0.045] and time to first oral intake [(4.43±2.10) vs (5.48±2.98) d, P=0.035] than the conventional gastric tube group. The incidences of gastroesophageal reflux (P=0.015) and intrathoracic gastric dilatation (P=0.026) were markedly lower in the coniform gastric tube group, whereas no significant intergroup differences were observed in the incidences of anastomotic leakage or anastomotic stricture (P> 0.05). At 6-month postoperative follow-up, better nutritional recovery was observed in the coniform gastric tube group, with significantly lower Patient-Generated Subjective Global Assessment (PG-SGA) scores (2.41± 1.03 vs 2.93±1.29, P=0.021), and objective nutritional indicators including serum total protein, albumin, prealbumin and hemoglobin were also significantly better than the conventional gastric tube group (all P< 0.05). For the secondary outcomes, the coniform gastric tube group exhibited milder inflammatory responses at 1 week postoperatively, with significantly lower levels of IL-10 [(7.85±0.61) vs (8.47±0.65) ng/L, P< 0.001], IL-6 [(21.37±4.72) vs (26.10±3.52) ng/L, P<0.001], and TNF-α [(14.18±2.94) vs (19.12±3.23) ng/L, P<0.001]. At 2 weeks postoperatively, gastrointestinal function recovery was obviously better in the coniform gastric tube group, with higher levels of motilin (MTL) [(117.85±16.61) vs (110.49±16.76) ng/L, P=0.023] and gastrin (GAS) [(62.58±15.72) vs (55.12±16.11) ng/L, P=0.016]. Quality of life assessment at 6 months postoperatively showed significantly higher scores in the coniform gastric tube group (75.38±7.16 vs 70.53± 7.24, P<0.05).

For patients undergoing inflatable mediastinoscopy combined with laparoscopic esophagectomy, coniform gastric tube reconstruction can effectively improve postoperative gastrointestinal function, reduce the risks of intrathoracic gastric dilatation and gastroesophageal reflux, promote postoperative nutritional status and enhance short-term quality of life, demonstrating clinical application value.