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Gjeorgjievski M, Imam Z, Cappell MS, Jamil LH, Kahaleh M. A Comprehensive Review of Endoscopic Management of Sleeve Gastrectomy Leaks. J Clin Gastroenterol 2021; 55:551-576. [PMID: 33234879 DOI: 10.1097/mcg.0000000000001451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery leaks result in significant morbidity and mortality. Experts report variable therapeutic approaches, without uniform guidelines or consensus. OBJECTIVE To review the pathogenesis, risk factors, prevention, and treatment of gastric sleeve leaks, with a focus on endoscopic approaches. In addition, the efficacy and success rates of different treatment modalities are assessed. DESIGN A comprehensive review was conducted using a thorough literature search of 5 online electronic databases (PubMed, PubMed Central, Cochrane, EMBASE, and Web of Science) from the time of their inception through March 2020. Studies evaluating gastric sleeve leaks were included. MeSH terms related to "endoscopic," "leak," "sleeve," "gastrectomy," "anastomotic," and "bariatric" were applied to a highly sensitive search strategy. The main outcomes were epidemiology, pathophysiology, diagnosis, treatment, and outcomes. RESULTS Literature search yielded 2418 studies of which 438 were incorporated into the review. Shock and peritonitis necessitate early surgical intervention for leaks. Endoscopic therapies in acute and early leaks involve modalities with a focus on one of: (i) defect closure, (ii) wall diversion, or (iii) wall exclusion. Surgical revision is required if endoscopic therapies fail to control leaks after 6 months. Chronic leaks require one or more endoscopic, radiologic, or surgical approaches for fluid collection drainage to facilitate adequate healing. Success rates depend on provider and center expertise. CONCLUSION Endoscopic management of leaks post sleeve gastrectomy is a minimally invasive and effective alternative to surgery. Their effect may vary based on clinical presentation, timing or leak morphology, and should be tailored to the appropriate endoscopic modality of treatment.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Zaid Imam
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Mitchell S Cappell
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Laith H Jamil
- Departments of Gastroenterology & Hepatology
- Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
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Li XK, Hua TT, Zhang C, Xu Y, Wu WJ, Zheng C, Wang GM, Qiang Y, Cong ZZ, Yi J, Shen Y. The ratio of gastric tube length to thorax length: a vital factor affecting leak after esophageal cervical anastomosis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:458. [PMID: 33850855 PMCID: PMC8039640 DOI: 10.21037/atm-20-6082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Esophagogastric anastomotic leak (AL) is a severe complication following esophageal resection. This study aims to explore preliminarily whether the ratio of the gastric conduit length to the thorax length can be regarded as a potential prognostic variable for AL, and if so, a cut-off value can be found to divide the patients into distinct risk groups. Methods We retrospectively reviewed the clinical data of 273 patients who underwent esophagectomy. The gastric conduit length, the thorax length, and other covariates were collected. Logistic regression was first conducted to probe the rationality of the ratio as a risk indicator of AL. Then the dichotomizing analysis was applied to find the optimal cut-off value. Results The incidence of AL was 12.5% (34/273). The coefficient of the ratio in the logistic regression equation was –7.901 with P<0.001, which indicated that the larger the ratio, the smaller the risk of AL. Further smoothed scatter plots revealed that a potential step function of the ratio of AL incidence exists, of which the steep part ranges from 1.74 to 1.90. Results of the accurate cut-off value search through a minimum P value approach give the optimal dichotomization point of 1.79. Conclusions The ratio of the gastric conduit length to the thorax length can reflect the tension in the anastomosis. The research proposes that surgeons can control the length of the gastric conduit during reconstruction to reduce the tension in the anastomosis and thus lead to a decrease in the incidence of AL.
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Affiliation(s)
- Xiao-Kun Li
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tian-Tian Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Chi Zhang
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Wen-Jie Wu
- Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
| | - Chao Zheng
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Ming Wang
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiang
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhuang-Zhuang Cong
- Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jun Yi
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Cardiothoracic Surgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China.,Department of Clinical Medicine, School of Medicine, Southeast University, Nanjing, China
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Nederlof N, Tilanus HW, de Vringer T, van Lanschot JJB, Willemsen SP, Hop WCJ, Wijnhoven BPL. A single blinded randomized controlled trial comparing semi-mechanical with hand-sewn cervical anastomosis after esophagectomy for cancer (SHARE-study). J Surg Oncol 2020; 122:1616-1623. [PMID: 32989770 PMCID: PMC7821322 DOI: 10.1002/jso.26209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim was to compare leak rate between hand-sewn end-to-end anastomosis (ETE) and semi-mechanical anastomosis (SMA) after esophagectomy with gastric tube reconstruction. BACKGROUND DATA The optimal surgical technique for creation of an anastomosis in the neck after esophagectomy is unclear. METHODS Patients with esophageal cancer undergoing esophagectomy with gastric tube reconstruction and cervical anastomosis were eligible for participation after written informed consent. Patients were randomized in 1:1 ratio. Primary endpoint was anastomotic leak rate defined as external drainage of saliva from the site of the anastomosis or intra-thoracic manifestation of leak. Secondary endpoints included anastomotic stricture rate at one year follow up, number of endoscopic dilatations, dysphagia-score, hospital stay, morbidity, and mortality. Patients were blinded for intervention. RESULTS Between August 2011 and July 2014, 174 patients with esophageal cancer underwent esophagectomy. Ninety-three patients were randomized to ETE (n = 44) or SMA (n = 49). Anastomotic leak occurred in 9 of 44 patients (20%) in the ETE group and 12 of 49 patients (24%) in the SMA group (absolute difference 4%, 95% CI -13% to +21%; p = .804). There was no significant difference in dysphagia at 1 year postoperatively (ETE 25% vs. SMA 20%; p = .628), in stricture rate (ETE 25% vs. 19% in SMA, p = .46), nor in median hospital stay (17 days in the ETE group, 13 days in the SMA group), morbidity (82% vs. 73%, p = .460) or mortality (0% vs. 4%, p = .175) between the groups.
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Affiliation(s)
- Nina Nederlof
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hugo W Tilanus
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tahnee de Vringer
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wim C J Hop
- Department of Biostatistics, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
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Contrast-enhanced swallow study sensitivity for anastomotic leak detection in post-esophagectomy patients. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mejía-Rivera S, Pérez-Marroquín SA, Cortés-González R, Medina-Franco H. Contrast-enhanced swallow study sensitivity for anastomotic leak detection in post-esophagectomy patients. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018. [PMID: 29525701 DOI: 10.1016/j.rgmx.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND AIMS Esophagectomy is a highly invasive surgery and one of its postoperative complications is anastomotic leakage, occurring in 53% of cases. The aim of the present study was to determine the sensitivity of the contrast-enhanced swallow study as a method for diagnosing anastomotic leak in patients that underwent esophagectomy. MATERIAL AND METHODS The present retrospective study included the case records of patients that underwent esophagectomy with reconstruction and cervical anastomosis at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán within the time frame of January 1, 2000 and May 31, 2016. Demographic, clinical, and laboratory data emphasizing clinical and radiographic anastomotic leak detection were identified. Descriptive statistics were carried out and contrast-enhanced swallow study sensitivity for diagnosing leakage was calculated. RESULTS Seventy patients were included in the analysis. The mean age of the patients was 50.6 years, 51 of the patients were men (72.86%), and 19 were women (27.14%). Indications for surgery were benign lesion in 29 patients (41.4%) and malignant lesion in 41 (58.6%). A total of 44.3% of the patients presented with a comorbidity, with diabetes mellitus and high blood pressure standing out. Thirty patients (42.85%) presented with anastomotic leak. Contrast-enhanced swallow study sensitivity for leak detection was 43.33%. CONCLUSIONS The diagnostic sensitivity of the contrast-enhanced swallow study was very low. Therefore, we recommend the discontinuation of its routine use as a method for diagnosing anastomotic leaks.
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Affiliation(s)
- S Mejía-Rivera
- Cirugía Oncológica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - R Cortés-González
- Cirugía Oncológica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - H Medina-Franco
- Cirugía Oncológica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Banasiewicz T, Dziki A, Lampe P, Lorenc Z, Szczepkowski M, Zieliński J, Wallner G. Anastomotic leaks in gastrointestinal surgery and their prevention. POLISH JOURNAL OF SURGERY 2017; 89:49-56. [PMID: 28537563 DOI: 10.5604/01.3001.0009.8979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anastomotic leak in the gastrointestinal tract is one of the most important complications of resection. They are the main cause of reoperation, their occurrence worsens the prognosis of the patient, increasing the proportion of direct mortality, as well as being a significant risk factor for recurrence of cancer. The risk of leaks within the gastrointestinal tract is greatly varied, depending on the location and extent of the resection, but also on patient, disease or a surgical procedure, including surgeon. To determine the potential risk of leakage can be significant for introduction some prophylactic actions. Some of them have the character of general recommendations, as proper nutrition of the patient in the perioperative period, while another part is directly connected to the surgical procedure. The second group includes protective stoma, the use of tissue glues, insertion transrectal drain for rectal anastomosis decompression, the use of stents or the use of collagen matrix coated with fibrinogen and thrombin. Important to reduce the proportion of leaks can be more precise and targeted prophylactic recommendations, based on the individualized determination of risk factors leaks. Further research for this purpose are necessary for this purpose, the big hope can be associated with data obtained through mobile applications.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej UM w Łodzi
| | - Paweł Lampe
- Katedra i Klinika Chirurgii Przewodu Pokarmowego Śląskiego Uniwersytetu Medycznego w Katowicach
| | - Zbigniew Lorenc
- Katedra i Oddział Kliniczny Chirurgii Ogólnej, Kolorektalnej i Urazów Wielonarządowych w Sosnowcu; Wydział Nauk o Zdrowiu Śląskiego Uniwersytetu Medycznego w Katowicach
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej Centrum Medycznego Kształcenia Podyplomowego w Warszawie
| | | | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego Uniwersytetu Medycznego w Lublinie
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Nederlof N, de Jonge J, de Vringer T, Tran TCK, Spaander MCW, Tilanus HW, Wijnhoven BPL. Does Routine Endoscopy or Contrast Swallow Study After Esophagectomy and Gastric Tube Reconstruction Change Patient Management? J Gastrointest Surg 2017; 21:251-258. [PMID: 27844264 PMCID: PMC5258812 DOI: 10.1007/s11605-016-3268-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/29/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anastomotic leakage is a severe complication after esophagectomy. The objective was to investigate the diagnostic and predictive value of routine contrast swallow study and endoscopy for the detection of anastomotic dehiscence in patients after esophagectomy. METHODS All patients who underwent contrast swallow and/or endoscopy within 7 days after oesophagectomy for cancer between January 2005 and December 2009 were selected from an institutional database. RESULTS Some 173 patients underwent endoscopy, and 184 patients underwent a contrast swallow study. The sensitivity of endoscopy for anastomotic leakage requiring intervention is 56 %, specificity 41 %, positive predictive value (PPV) 8 %, and negative predictive value (NPV) 95 %. The sensitivity of contrast swallow study for detecting leakage requiring intervention in patients without signs of leakage was 20 %, specificity 20 %, PPV 3 %, and NPV 97 %. CONCLUSIONS In patients without clinical suspicion of leakage, there is no benefit to perform routine examinations.
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Affiliation(s)
- N. Nederlof
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus MC University Medical Centre Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - J. de Jonge
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus MC University Medical Centre Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - T. de Vringer
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus MC University Medical Centre Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - T. C. K. Tran
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus MC University Medical Centre Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - M. C. W. Spaander
- 000000040459992Xgrid.5645.2Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - H. W. Tilanus
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus MC University Medical Centre Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - B. P. L. Wijnhoven
- 000000040459992Xgrid.5645.2Department of Surgery, Erasmus MC University Medical Centre Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Abstract
In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pHi) is a method to identify anaerobic metabolism as a sign of impaired perfusion. In this study we aimed to monitor changes in the perfusion of the gastric conduit at key steps during and after esophagectomy. pHi was measured per- and postoperatively using intermittent gastric tonometry in 32 patients undergoing open, 65%, or video-assisted thoracoscopic esophagectomy for esophageal cancer. Measurements focused on the surgical steps when the vascular supply to the gastric conduit was altered. A tonometry catheter was successfully placed in all patients and a decrease in pHi (mean ± SD) was observed from baseline to after the division of the short gastric vessels (7.33 ± 0.07 to 7.29 ± 0.07, P = 0.005). A further reduction after the ligation of the left gastric artery (7.26 ± 0.08, P < 0.001) and after final linear stapling the gastric conduit (7.15 ± 0.13, P < 0.001) was observed. Two hours after surgery, pHi increased (7.24 ± 0.09, P = 0.002). In contrast to open surgery, a trend towards less reduction in pHi was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pHi on the first postoperative day (7.12 ± 0.05 vs. 7.27 ± 0.08, P = 0.040). It can be concluded that each surgical step altering the vascular supply to the gastric conduit resulted in detectable changes, however transient, in pHi. Patients with low pHi on the first postoperative day were more prone to have clinically relevant anastomotic leaks.
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Affiliation(s)
- Gustav Linder
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Zhou C, Ma G, Li X, Li J, Yan Y, Liu P, He J, Ren Y. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol 2015; 13:269. [PMID: 26338060 PMCID: PMC4560054 DOI: 10.1186/s12957-015-0661-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023] Open
Abstract
Background Compared with open esophagectomy (OE), minimally invasive esophagectomy (MIE) proves to have clear benefits in reducing the risk of pulmonary complications for patients with resectable esophageal cancer. The objectives of our study were to explore the superiority of MIE in reducing the occurrence of anastomotic leakages (ALs) when compared to OE. Methods A systematic review and meta-analysis was performed to assess the superiority of MIE on the occurrence of ALs over OE, by searching many sources (through December, 2014) such as Medline, Embase, Wiley Online Library, and Cochrane Library. Fixed-effects model was used to calculate summary odds ratios (ORs) to quantify associations between OE and MIE groups. Cochran’s Q and I2 statistics were used to evaluate heterogeneity among studies. Results Among a total of 43 studies involving 5537 patients included in the meta-analysis, 2527 (45.6 %) cases underwent MIE and 3010 (54.4 %) cases underwent OE. Compared to patients undergoing OE, patients undergoing MIE did not have statistical significance in reduced occurrence of ALs (OR = 0.97, 95 % CI = 0.80–1.17). Insignificant reduced occurrence of ALs was not associated with anastomotic location (OR = 0.90, 95 % CI = 0.71–1.13) or anastomotic procedure (OR = 1.02, 95 % CI = 0.79–1.30). Conclusions More proofs are needed to clarify the strengths or weaknesses of MIE in preventing anastomotic leakages after esophagectomy for cancer. A largely randomized, controlled trial should be undertaken to resolve this contentious issue urgently.
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Affiliation(s)
- Can Zhou
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Gang Ma
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Xiao Li
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China
| | - Juan Li
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Yu Yan
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China
| | - Peijun Liu
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China
| | - Jianjun He
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
| | - Yu Ren
- Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
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Lindner K, Fritz M, Haane C, Senninger N, Palmes D, Hummel R. Postoperative complications do not affect long-term outcome in esophageal cancer patients. World J Surg 2015; 38:2652-61. [PMID: 24867467 DOI: 10.1007/s00268-014-2590-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND As esophagectomy is associated with a considerable complication rate, the aim of this study was to assess the impact of postoperative complications and neoadjuvant treatment on long-term outcome of adenocarcinoma (EAC) and squamous cell carcinoma (SCC) patients. METHODS Altogether, 134 patients undergoing transthoracic esophagectomy between 2005 and 2010 with intrathoracic stapler anastomosis were included in the study. Postoperative complications were allocated into three main categories: overall complications, acute anastomotic insufficiency, and pulmonary complications. Data were collected prospectively and reviewed retrospectively for the purpose of this study. RESULTS SCC patients suffered significantly more often from overall and pulmonary complications (SCC vs. EAC: overall complications 67 vs. 45 %, p = 0.044; pulmonary complications 56 vs. 34 %, p = 0.049). The anastomotic insufficiency rates did not differ significantly (SCC 11%, EAC 15%, p = 0.69). Long-term survival of EAC and SCC patients was not affected by perioperative (overall/pulmonary) complications or by the occurrence of anastomotic insufficiency. Also, neoadjuvant treatment did not influence the incidence of complications or long-term survival. CONCLUSIONS This is the first time the patient population of a center experienced with esophageal cancer surgery was assessed for the occurrence of general and esophageal cancer surgery-specific perioperative complications. Our results indicated that these complications did not affect long-term survival of EAC and SCC patients. Our data support the hypothesis that neoadjuvant treatment might not affect the incidence of perioperative complications or long-term survival after treatment of these tumor subtypes.
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Affiliation(s)
- Kirsten Lindner
- Department of General and Visceral Surgery, Muenster University Hospital, Waldeyerstr. 1, 48149, Münster, Germany,
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Vermeer T, Orsini R, Daams F, Nieuwenhuijzen G, Rutten H. Anastomotic leakage and presacral abscess formation after locally advanced rectal cancer surgery: Incidence, risk factors and treatment. Eur J Surg Oncol 2014; 40:1502-9. [DOI: 10.1016/j.ejso.2014.03.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 03/04/2014] [Accepted: 03/18/2014] [Indexed: 12/13/2022] Open
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Larburu Etxaniz S, Gonzales Reyna J, Elorza Orúe JL, Asensio Gallego JI, Diez del Val I, Eizaguirre Letamendia E, Mar Medina B. [Cervical anastomotic leak after esophagectomy: diagnosis and management]. Cir Esp 2012. [PMID: 23199473 DOI: 10.1016/j.ciresp.2012.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cervical anastomotic leaks after esophagectomy are still a frequent and severe complication that needs an early diagnosis and an appropriate treatment. The aim of this study was to describe our experience with the management of this complication. PATIENTS AND METHODS Retrospective study (2003-2011) of a consecutive series of 77 patients with a cervical esophagogastric anastomosis, 18 of them (23.3%) presenting a leak. Fistulae were classified into 4 groups depending on clinical presentation, radiology (esophagogram or CT), surgical findings (in case of re-operation) and, since 2010, endoscopic examination. Type I leaks were an asymptomatic or radiographic leak, type II had local signs limited to the neck, type III was associated with respiratory symptoms due to a pleural or mediastinal collection, and type IV with a systemic disorder secondary to gastric necrosis. RESULTS Four patients (22.2%) were classified as type I, 8 (44.4%) as type II, 3 (16.6%) as type III, and 3 (16.6%) as type IV. Eight patients were managed conservatively; in 9 a self-expanding stent was used, 5 required a thoracotomy, and one of them (type IV) died. Leaks were related to a higher associated morbidity (61 versus 30%; P=.019) and a longer hospital stay (median of 28.5 vs 14 days; P=.009). CONCLUSIONS Almost one quarter of cervical esophagogastric anastomoses present some kind of anastomotic leak. Although most of them can be treated conservatively or by endoscopy, they are associated with an increase in morbidity and mortality.
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Yoo HM, Lee HH, Shim JH, Jeon HM, Park CH, Song KY. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol 2011; 104:734-40. [PMID: 21792945 DOI: 10.1002/jso.22045] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 07/05/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Leakage has been shown to adversely affect survival in patients undergoing surgery for gastrointestinal malignancies. However, the effect of leakage following radical gastrectomy in patients with gastric cancer remains unclear. METHODS In total, 478 patients with advanced gastric cancer who underwent surgery with curative intent were reviewed. Anastomosis or duodenal stump leakage was diagnosed clinically or radiologically. Risk factors for leakage were evaluated by univariate and multivariate analyses. The impact of leakage on patient survival was analyzed using the Kaplan-Meier method. RESULTS Leakage was diagnosed in 32 of 478 patients (6.7%); 14 patients (2.9%) exhibited esophagojejunal anastomotic leakage, 14 (2.9%) showed duodenal stump leakage, and four (0.8%) showed gastroduodenal anastomotic leakage. Poor performance status [odds ratio (OR): 4.01, 95% confidence interval (CI): 1.80-8.93] and tumor location (OR: 3.74, 95% CI: 1.56-8.89) were risk factors for postoperative leakage. Overall mean survival of patients with leakage was significantly lower than that of patients without leakage (30.5 vs. 96.2 months; P < 0.001). Leakage was one of the independent predictive factor for overall survival [hazard ratio (HR): 3.58, 95% CI: 2.29-5.59]. CONCLUSIONS Postoperative inflammation due to leakage is a negative prognostic factor for patients with advanced gastric cancer.
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Affiliation(s)
- Han Mo Yoo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Teoh AYB, Chiu PWY, Lau JYW, Ng EKW. Randomized comparative trial of a novel one-step needle sphincterotome versus direct incision and balloon dilation used to create gastrotomies for natural orifice translumenal endoscopic surgery (NOTES) in the porcine model. Surg Endosc 2011; 25:3116-21. [PMID: 21487882 DOI: 10.1007/s00464-011-1653-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 02/20/2011] [Indexed: 01/09/2023]
Affiliation(s)
- Anthony Yuen Bun Teoh
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
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15
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16
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Schuchert MJ, Abbas G, Nason KS, Pennathur A, Awais O, Santana M, Pereira R, Oostdyk A, Luketich JD, Landreneau RJ. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery 2010; 148:831-8; discussion 838-40. [PMID: 20800864 DOI: 10.1016/j.surg.2010.07.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 07/13/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND The development of anastomotic leaks and/or strictures can be associated with considerable morbidity and impairment of quality of life. In the current study, we evaluated the outcomes of patients who developed anastomotic complications after esophagectomy to elucidate the impact of these events on morbidity, mortality, and subsequent need for dilation. METHODS We analyzed retrospectively the clinical course of 235 patients who underwent transhiatal esophagectomy for cancer from 2001 to 2009. Patients with confirmed anastomotic leaks were identified and classified with the following scale: class 1: Radiographic leak only, no intervention; class 2: leak requiring opening of the wound, cervical and/or percutaneous drainage; class 3: disruption of anastomosis (10-50% circumference) with perianastomotic abscess requiring video-assisted thoracoscopic surgery or thoracotomy; and class 4: gastric tip necrosis with anastomotic separation (>50% circumference). RESULTS Anastomotic leaks were encountered in 30 patients (13%). Anastomotic leaks were associated with greater morbidity (70% vs 47%; P = .02) and stricture formation (57% vs 19%; P = .0001). Mortality was not different. Increasing leak class was associated with an increased need for postoperative anastomotic dilations (P = .016). CONCLUSION Anastomotic integrity after esophagectomy has a substantial impact on perioperative course and long-term swallowing. A more formal radiographic and endoscopic leak classification system seems justified.
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Affiliation(s)
- Matthew J Schuchert
- Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Pittsburgh, PA 15232, USA.
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17
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Clinical implication of positive oral contrast computed tomography for the evaluation of postoperative leakage after gastrectomy for gastric cancer. J Comput Assist Tomogr 2010; 34:537-42. [PMID: 20657221 DOI: 10.1097/rct.0b013e3181dbe579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness of positive oral contrast computed tomography (CT) for the detection of leakage and its relationship with the immediate postoperative outcome after gastrectomy for gastric cancer. METHODS A total of 210 patients with a clinical suspicion of leakage after gastrectomy for gastric cancer underwent a positive oral contrast CT. Two radiologists retrospectively reviewed the CT images, recorded the presence of extraluminal contrast leakage, and graded the amount of leaked contrast. The rate of postoperative intervention treatment, the length of postoperative hospital stay, and mortality rates were correlated with the presence and grades of leakage. Matching accuracy between CT and other diagnostic studies in detection of leakage was also evaluated. RESULTS There were 162 patients without extraluminal contrast leakage (77.1%), 13 with grade 1 leakage (6.2%), 19 with grade 2 (9.0%), and 16 with grade 3 (7.6%). Postoperative intervention rate, hospital stay, and mortality were significantly higher in patients with extraluminal contrast than those in patients without extraluminal contrast (P < 0.05). Postoperative hospital stays increased as the leakage grades increased (P = 0.0008). The matching accuracy between CT and other studies was 82.1% (n = 32/39). CONCLUSIONS Positive oral contrast CT can be a reliable tool for diagnosing postoperative leakage that requires further intervention after gastrectomy in gastric cancer patients, and the immediate postoperative outcome may be related with the grade of leaked contrast on CT.
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Theodorou D, Drimousis PG, Larentzakis A, Papalois A, Toutouzas KG, Katsaragakis S. The effects of vasopressors on perfusion of gastric graft after esophagectomy. An experimental study. J Gastrointest Surg 2008; 12:1497-501. [PMID: 18612706 DOI: 10.1007/s11605-008-0575-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 06/04/2008] [Indexed: 01/31/2023]
Abstract
AIMS To evaluate the impact of the perioperative administration of norepinephrine on the perfusion of the esophageal graft. METHODS This is an experimental study. Six swine underwent transhiatal esophagectomy; the stomach was used to replace the resected esophagus. We provoked hemorrhagic shock to the animals and then we administered noradrenaline to restore the blood pressure. We monitored the graft perfusion perioperatively using the technique of microdialysis. RESULTS In all animals, the graft experienced severe hypoperfusion after the administration of noradrenaline that was statistically significant. CONCLUSIONS Our data support the hypothesis that norepinephrine should be used with extreme caution in the perioperative setting after esophagectomy. Further studies, however, will be required to evaluate the clinical significance of this finding.
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Affiliation(s)
- Dimitrios Theodorou
- 1st Department of Propaedeutic Surgery, Athens Medical School, University of Athens, Hippocration General Hospital of Athens, Athens, Greece
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19
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Chiu PW, Lau JY, Ng EK, Lam CC, Hui M, To KF, Sung JJ, Chung SS. Closure of a gastrotomy after transgastric tubal ligation by using the Eagle Claw VII: a survival experiment in a porcine model (with video). Gastrointest Endosc 2008; 68:554-9. [PMID: 18635172 DOI: 10.1016/j.gie.2008.03.1110] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 03/25/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transgastric access to the peritoneal cavity presents new opportunities for novel endoscopic surgery. Secure closure of the gastrotomy site is critical to the success of transgastric endoscopic surgery. OBJECTIVE To study the safety and efficacy of closure of a gastrotomy by using the Eagle Claw VII endoscopic suturing device after transgastric bilateral tubal ligation. DESIGN A prospective survival study in a porcine model with ten 30-kg pigs. INTERVENTIONS The gastrotomies were made by using a needle-knife and balloon dilation. Bilateral fallopian tube ligation was performed with detachable snares, and the tubes were transected by using the needle-knife. The gastrotomies were closed with endoscopic suturing by using the Eagle Claw VII. MAIN OUTCOME MEASUREMENTS Included the survival of the pigs, security of the closure, number of plicating sutures used, operative time, peritoneal contamination, and histopathologic confirmation of the full-thickness healing of the gastrotomy. RESULTS Transgastric fallopian-tube ligation was performed in 10 pigs, and all of the gastrotomies were successfully closed by using the Eagle Claw VII endoscopic suturing device. The operative time for bilateral tubal ligation was 38.2 minutes (range 18-50 minutes), whereas, the operative time for gastrotomy closure was 25.5 minutes (range 15-35 minutes). Three endoscopic sutures were necessary to achieve a secure gastrotomy closure. All the pigs survived and tolerated a full diet 24 hours after the operation. A postmortem confirmed full-thickness healing for all gastrotomies, with no evidence of leakage. One pig had an overtube-related esophageal perforation, which was successfully managed with endoscopic clip closure. LIMITATIONS The porcine gastric wall is thicker than the human gastric wall, and the posterior wall of the porcine stomach becomes the anterior-inferior wall after gaseous distention. Hence, all the gastrotomies were made through the posterior wall. The tissue tolerance and healing of the porcine stomach may be different from that of the human stomach. CONCLUSIONS Endoscopic suturing by using the Eagle Claw VII device is a feasible method for gastrotomy closure after a natural orifice transluminal endoscopic surgery procedure.
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Affiliation(s)
- Philip W Chiu
- Institute of Digestive Disease, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
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20
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Zhu ZJ, Zhao YF, Chen LQ, Hu Y, Liu LX, Wang Y, Kou YL. Clinical application of layered anastomosis during esophagogastrostomy. World J Surg 2008; 32:583-8. [PMID: 18210181 DOI: 10.1007/s00268-007-9396-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma.
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Affiliation(s)
- Zi-Jiang Zhu
- Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, Sichuan 610041, China.
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21
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Cuenca-Abente F, Assalia A, del Genio G, Rogula T, Nocca D, Ueda K, Gagner M. Laparoscopic partial gastric transection and devascularization in order to enhance its flow. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2008; 2:3. [PMID: 18606017 PMCID: PMC2478649 DOI: 10.1186/1750-1164-2-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 07/07/2008] [Indexed: 12/12/2022]
Abstract
Background Esophagogastric fistula following an esophagectomy for cancer is very common. One of the most important factors that leads to its development is gastric isquemia. We hypothesize that laparoscopic gastric devascularization and partial transection is a safe operation that will enhance the vascular flow of the fundus of the stomach. Method Our study included eight pigs. Each animal had two operations. In the first one, a laparoscopic gastric devascularization and mobilization took place. Vascular flow was measured previous to the procedure and immediately after it with a laser doppler (endoscopic probe). After three weeks, a second operation took place. We re-measured the vascular flow and sent a sample of gastric fundus for histopathologic evaluation. Results The gastric fundus showed signs of neovascularization after both macroscopic and microscopic evaluation. These findings correlated with laser doppler measurements. Conclusion Laparoscopic gastric devascularization and partial transection is a safe procedure that increases the vascular flow of the stomach in a three week period. This finding can have a positive impact in terms of decreasing fistula formation.
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Affiliation(s)
- Federico Cuenca-Abente
- Division of Laparoscopic Surgery, Mount Sinai Minimally Invasive Surgery Center (MSMISC), Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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22
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Buunen M, Rooijens PPGM, Smaal HJ, Kleinrensink GJ, van der Harst E, Tilanus HW, Lange JF. Vascular anatomy of the stomach related to gastric tube construction. Dis Esophagus 2008; 21:272-4. [PMID: 18430111 DOI: 10.1111/j.1442-2050.2007.00771.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In view of constructing a gastric tube after esophagus resection, the vascular anatomy of the greater curvature of the stomach, especially the connection between the left and right gastro-epiploic arteries, was investigated. The vascular anatomy was studied in 20 embalmed human specimens. After dissection a gastric tube of 4 cm wide was constructed, using the greater gastric curvature. Various lengths of the arterial arcades were measured. In 70% an anastomosis between the right and left gastro-epiploic arteries was present. With the construction of an isoperistaltic gastric tube, in which the left gastro-epiploic artery is left in situ (ligating it at the splenic hilus), there is an 18.7% increase of length of arterial arcade along the gastric tube. Leaving the left gastro-epiploic artery in situ increases the feeding arterial arcaded-length along the gastric tube with 5.0 cm (19%).
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Affiliation(s)
- M Buunen
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
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23
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Hogan BA, Winter DC, Winter D, Broe D, Broe P, Lee MJ. Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery. Surg Endosc 2007; 22:767-71. [PMID: 18071817 DOI: 10.1007/s00464-007-9629-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 08/10/2007] [Accepted: 09/03/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anastomotic leaks are a major complication of oesophagogastric surgery. We compare contrast swallow fluoroscopy, computed tomography (CT) with oral contrast and endoscopy in identifying anastomotic leaks following oesophagogastric surgery. METHODS A prospective trial of 38 patients undergoing oesophagogastric resection was undertaken with informed consent and institutional review board (ethics committee) approval. Patients underwent all three investigations (over 24 hours) 1 week postoperatively. RESULTS Eight (21%) had clinically apparent leaks. Three pseudo-leaks were suggested on contrast swallow but were confirmed normal on CT and endoscopy. Contrast swallow and CT missed one anastomotic leak each. Endoscopy identified anastomotic defects in three patients, in whom CT and contrast swallow were either normal or conflicting. CONCLUSIONS Routine tests of anastomotic integrity are unnecessary. When clinically suspected, contrast swallow or CT with oral contrast will identify most leaks. Endoscopy is useful in cases where there are incongruous results.
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Affiliation(s)
- Brian A Hogan
- Department of Radiology, R.C.S.I. Educational & Research Centre, Beaumont Hospital, Dublin 9, Ireland.
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24
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Abstract
Anastomotic leaks continue to be a source of considerable morbidity and mortality after esophageal resection. Careful attention to the contributing factors to the development of a leak, particularly conduit ischemia and anastomotic technique, can reduce the incidence of anastomotic complications postoperatively. Selective management of leaks, including non-operative treatment when indicated, will maximize the chance for a successful outcome.
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Affiliation(s)
- John D Mitchell
- Section of Thoracic Surgery, University of Colorado School of Medicine, Denver 80262, USA.
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25
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Abstract
AIM: Leakage from oesophageal anastomosis is associated with substantial morbidity and mortality. This study presented a novel, safe and effective double stapled technique for oesophago-enteric anastomosis.
METHODS: The data were obtained prospectively from hospital held clinical database. Thirty nine patients (26 males, 13 females) underwent upper-gastrointestinal resection between 1996 and 2000 for carcinoma (n = 36), gastric lymphoma (n = 1), and benign pathology (n = 2). Double stapled oesophago-enteric anastomosis was performed in all cases.
RESULTS: No anastomotic leak was reported. In cases of malignancy, the resected margins were free of neoplasm. Three deaths occurred, which were not related to anastomotic complications.
CONCLUSION: Even though the reported study is an uncontrolled one, the technique described is reliable, and effective for oesophago-enteric anastomosis.
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Affiliation(s)
- A Kotru
- Department of Surgery, Airedale General Hospital, Keighly, UK
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26
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Caporossi C, Cecconello I, Aguilar-Nascimento JE, Venço F, Gama-Rodrigues JJ. Hand-sewn and stapled esophageal anastomosis: experimental study in dogs. Acta Cir Bras 2004. [DOI: 10.1590/s0102-86502004000400002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To compare experimentally, the healing of cervical oesophageal anastomoses performed either with stapler or 2-layer hand-sewn sutures. METHODS: Thirty six dogs were randomised to two groups: stapled anastomoses (n = 18); hand-sewn anastomoses (n = 18). Each group was divided into three subgroups, corresponding to the day of sacrifice (3rd, 7th and 14th postoperative day). Healing was assessed by: a) anatopathology b) anastomotic resistance to bursting pressure test; c) quantification of hidroxyproline RESULTS: Group 1 heal by second intention, group 2 showed a healing by first intention. Bursting pressure was similar between groups at day 3, though group 1 animals showed it significantly higher at day 7and day 14 compared with group 2. Statiscally, there were no interaction between the day of sacrifice and groups, as well as there was no difference among the dates of observation regarding the results of hidroxyproline CONCLUSIONS: a) mechanical suture is more resistant than hand-sewn; b) In stapler anastomoses, healing was as secondary union, whereas in hand-sewn anastomoses, healing was by first intention; c) no correlation was found in the results of bursting pressure and hidroxyproline quantification.
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27
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Alfabet C, Montero EFDS, Paes Leme LF, Higashi VS, Sallum Fo CFC, Fagundes DJ, Gomes PO. Progressive gastric perfusion in rats: role of ischemic conditioning. Microsurgery 2004; 23:513-6. [PMID: 14558013 DOI: 10.1002/micr.10164] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Occult ischemia of the mobilized stomach is usually related to the dehiscence of an esophagogastric anastomosis. The principle of ischemic conditioning was studied to verify its clinic use. This study aims to evaluate progressively the tissue perfusion of the stomach in ischemic conditioning, establishing the best moment for gastric transposition. Twenty-four male EPM-1 Wistar rats were used, which also underwent partial desvacularization of the stomach by ligature of the left gastric vessels. Tissue perfusion was measured through flowmetry by laser Doppler (tissue perfusion unit; TPU) in the antrum (10 mm distal from the cardiac region). This measurement was done before (baseline) and immediately after the ligature, and on different postoperative days (POD) (days 3, 7, 10, and 14). A statistical analysis was done with nonparametric tests (P <or= 0.05). The mean value (+/-SD) of the gastric perfusion, during the whole study period, was 88 +/- 6 (baseline), 23 +/- 5 (postligature), 31 +/- 5 (3rd POD), 55 +/- 4 (7th POD), 71 +/- 16 (10th POD), and 84 +/- 6 (14th POD), respectively. Perfusion immediately after the artery ligature was significantly lower (74%) than the baseline of the gastric perfusion; therefore, in the following days, tissue perfusion increased progressively (35%, 63%, 81%, and 96%, respectively). The flowmetry of the stomach reached basal values in the 14th POD of desvascularization, suggesting that this would the best day to perform a gastric transposition. However, on the 10th POD, good tissue perfusion was observed. The extrapolation from these data to the clinic could improve the results of esophagogastric anastomosis.
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Affiliation(s)
- Charles Alfabet
- Disciplina de Técnica Operatória e Cirurgia Experimental, Departamento de Cirurgia, Universidade Federal de São Paulo, São Paulo, Brazil
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Miyazaki T, Kuwano H, Kato H, Yoshikawa M, Ojima H, Tsukada K. Predictive value of blood flow in the gastric tube in anastomotic insufficiency after thoracic esophagectomy. World J Surg 2002; 26:1319-23. [PMID: 12297918 DOI: 10.1007/s00268-002-6366-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anastomotic insufficiency is considered to be one of the most serious complications associated with esophageal reconstruction. The purposes of this study were to identify (1) the relationship between anastomotic insufficiency and tissue blood flow (TBF) in the gastric tube in the perioperative period, and (2) the effects of intravenous prostaglandin E1 (PGE1) on TBF in the gastric tube. The study group consisted of 44 patients who were to undergo esophagectomy for esophageal cancer. Intraoperative and postoperative TBF on the serosal side of the gastric tube were measured by laser-Doppler tissue blood flowmetry. The TBF of the Leakage(+) group (n = 5) was poorer than that of the Leakage(?) group (n = 39) during the intraoperative and postoperative periods. There was a significant difference in TBF between the two groups at postoperative day (POD) 3. There was a tendency in the PGE1(+) group (n = 18) to exhibit richer blood flow through the anastomosis than the PGE1(?) group (n = 26), intraoperatively, but the difference was not significant. Two of five Leakage(+) cases were also in the PGE1(+) group. There was no relationship between intraoperative medication with PGE1 and incidence of leakage. The TBF of three-field lymph node dissection and reconstruction of the retrosternal route group (n = 21) was poorer than that of the two-field lymph-node dissection and reconstruction of the posterior mediastinal route group (n = 23). The TBF in the gastric tube after esophagectomy may be a predictor of anastomotic insufficiency. However, PGE1 treatment in the intraoperative period alone is not effective in preventing anastomotic insufficiency.
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Affiliation(s)
- Tatsuya Miyazaki
- Department of Surgery I, Gunma University Faculty of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001; 88:1157-68. [PMID: 11531861 DOI: 10.1046/j.0007-1323.2001.01829.x] [Citation(s) in RCA: 504] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently used as an indicator of the quality of surgical care provided. Comparison of rates between and within institutions depends on the use of standard definitions and methods of measurement of anastomotic leak. The aim of this study was to review the definition and measurement of anastomotic leak after oesophagogastric, hepatopancreaticobiliary and lower gastrointestinal surgery. METHODS A systematic review was undertaken of the published literature. Searches were carried out on five bibliographical databases (Medline, Embase, The Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and HealthSTAR) for English language articles published between 1993 and 1999. Articles were critically appraised by two independent reviewers and data on definition and measurement of anastomotic leak were extracted. RESULTS Ninety-seven studies were reviewed and a total of 56 separate definitions of anastomotic leak were identified at three sites: upper gastrointestinal (13 definitions), hepatopancreaticobiliary (14) and lower gastrointestinal (29). The majority of studies used a combination of clinical features and radiological investigations to define and detect anastomotic leak. CONCLUSION There is no universally accepted definition of anastomotic leak at any site. The definitions and values used to measure anastomotic failure vary extensively and preclude accurate comparison of rates between studies and institutions.
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Affiliation(s)
- J Bruce
- Department of Public Health, University of Aberdeen, Medical School, Polwarth Building, Aberdeen AB25 2ZD, UK.
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30
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Whooley BP, Law S, Alexandrou A, Murthy SC, Wong J. Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer. Am J Surg 2001; 181:198-203. [PMID: 11376570 DOI: 10.1016/s0002-9610(01)00559-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Leakage from esophageal anastomoses is higher than that for other gastrointestinal anastomoses. An intrathoracic anastomotic leak is a potentially catastrophic event. METHODS Patients with and without thoracic anastomotic leakage were compared for predisposing factors. Leak-related mortality was analyzed. RESULTS Of 475 patients, there were 17 leaks (3.5%). Predisposing technical factors occurred significantly more frequently in patients who leaked. Sixteen such events were identified as contributory in 11 patients. The hospital mortality for patients who leaked was significantly higher (35% versus 9%, P = 0.005). Inadequate drainage and persistent sepsis accounted for 4 of the 6 deaths. The need for inotropic support postoperatively correlated with leak-related mortality (66% versus 0%, P = 0.006), while leak size, time to diagnosis, or method of drainage did not. CONCLUSIONS Thoracic anastomotic leaks are largely preventable. Leak-related mortality for the series was 1% and was most commonly related to inadequate drainage.
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Affiliation(s)
- B P Whooley
- Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, People's Republic of China
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31
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Yannopoulos P, Katsoulis I, Chatzikonstantinou G, Veloudis G. Massive distension of the esophageal stump after cervical esophagogastrostomy in psychiatric patients. Dis Esophagus 2001; 13:248-50. [PMID: 11206643 DOI: 10.1046/j.1442-2050.2000.00121.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present two similar cases of huge distension of the esophageal stump after cervical esophagogastrostomy in two psychotic patients. Chronic use of anti-psychotic drugs, in combination with prolonged mild anastomotic stricture, may have contributed to this situation.
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Affiliation(s)
- P Yannopoulos
- 2nd Surgical Department of the Evangelismos General Hospital, Athens, Greece
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Whooley BP, Wong J. Intrathoracic oesophageal anastomosis: is it worth the risk? THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:677-80. [PMID: 10976899 DOI: 10.1046/j.1440-1622.2000.01923.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- B P Whooley
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital
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Abstract
Chronologically, complications can be classified as intraoperative, early, and late. The authors analyze complications according to this classification on the basis of more than 400 esophageal operations and related literary data. As regards intraoperative complications, they deal only with those occurring at transhiatal esophagectomy (e.g., tracheal tear, bleeding, pneumothorax, laryngeal nerve injury). Among the early complications, they survey the incidence of transplant necrosis and related mortality, further sequelae ensuing from subacute ischemia of the replaced organ and analyze in detail the questions which arise regarding anastomotic leakage. Firstly, they deal with those causative factors that influence the frequency of anastomotic insufficiency, such as the technical "know-how" of anastomosis making (e.g., one layer vs two layers; stapling or manual suture; interrupted or running suture), the way of replacement using whole stomach or tube-stomach and the consequences originating from the route of replacement (e.g., anterior or posterior mediastinal route). Incidence and management of chylothorax are also dealt with. While dealing with late complications, the authors give a detailed comment on anastomotic strictures and also other factors facilitating the development of late dysphagia, such as peptic stricture and tumor of the organ remnant. Finally, some cases successfully treated by surgery are presented (skin-tube formation in cases following transplant necrosis; abolition of a pharyngogastric anastomosis stricture using a free jejunal transplant and surgical solution of an anastomotic stricture from median sternotomy approach).
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Affiliation(s)
- O P Horváth
- First Department of Surgery, University Medical School of Pécs, Hungary
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Abstract
The etiology of esophagogastric anastomotic leaks is often multifactorial. However, occult ischemia of the gastric fundus is an important cause. In gastric conditioning, preliminary partial gastric devascularization is carried out 2-3 weeks before construction of the esophagogastric anastomoses. Gastric vascularity improves over this time. In animal studies, gastric conditioning has reduced the incidence of anastomotic leaks. Clinically, the concept of gastric conditioning can be used in several ways. Esophagectomy can be done at one stage, then a cervical esophagogastric anastomosis can be completed as a second-stage procedure. Pre-esophagectomy angiographic gastric artery embolization is another method of gastric conditioning. Finally, laparoscopic partial gastric devascularization can be done at the time of laparoscopic cancer staging. For gastric conditioning to be clinically useful, the benefit from reduction in leaks must be greater than the costs and morbidity of the conditioning procedure itself.
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Affiliation(s)
- J D Urschel
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA
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Abstract
Anastomotic failure remains to be one of the main problems in esophageal surgery with leakage rates up to 30% being reported currently. We addressed that problem by modifying the gastric-tube formation in utilizing all of the gastric fundus and omitting the resection of the lesser gastric curvature and accompanying vessels. Experimentally, those fundus-rotation gastroplasties were significantly longer and better perfused than conventional gastroplasties. In a clinical series of 53 patients (45 male, eight female, range 42-83 years) undergoing esophageal resection (49 malignancies, four non-malignant esophageal disease), four anastomotic leakages were found (7.5%). Three patients died due to a bronchial leak and adult respiratory distress syndrome, one with a complete gastric-tube necrosis and one with a colon perforation, sepsis and multiorgan failure. Eight patients developed a significant anastomotic stricture requiring repeated endoscopic dilatations. From our experimental and clinical experience, we conclude that the favorable length and perfusion of fundus-rotation gastroplasties allow for safe anastomosis at either the cervical or thoracic level.
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Affiliation(s)
- M K Schilling
- Department for Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland
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Murakami M, Sugiyama A, Ikegami T, Ishida K, Maruta F, Shimizu F, Ikeno T, Kawasaki S. Revascularization using the short gastric vessels of the gastric tube after subtotal esophagectomy for intrathoracic esophageal carcinoma. J Am Coll Surg 2000; 190:71-7. [PMID: 10625235 DOI: 10.1016/s1072-7515(99)00234-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maintaining sufficient blood flow to the substitutive organ after esophagectomy is essential to decrease the risk of anastomotic leakage. STUDY DESIGN Forty-one patients underwent subtotal esophagectomy for intrathoracic esophageal carcinoma and reconstruction using the gastric tube. Additional vascular anastomosis between the short gastric vessels and the vessels in the neck was performed in 15 patients. Tissue blood flow was measured by laser Doppler flowmetry before and after vascular anastomosis. The incidence of anastomotic leakage in the revascularization group was compared with that in the remaining 26 patients. RESULTS Venous anastomosis was performed in 14 patients and arterial anastomosis in 9. There was a significant increase in tissue blood flow after venous anastomosis alone (mean percent increase: 36%; p < 0.01), and after arterial and venous anastomoses (mean percent increase: 108%; p < 0.01). No anastomotic leakage was observed in the revascularization group; six patients (23.1%) in the control group had leakage (p < 0.05). Patients in the revascularization group started taking a meal 10.0 +/- 0.4 days postoperatively, compared with 15.1 +/- 1.8 days in the control group (p < 0.05). CONCLUSIONS Additional vascular anastomosis in esophageal reconstruction after subtotal esophagectomy achieved good results. This procedure can reduce the risk of anastomotic leakage and may be useful for esophageal reconstruction.
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Affiliation(s)
- M Murakami
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Pierie JP, de Graaf PW, van Vroonhoven TJ, Obertop H. Healing of the cervical esophagogastrostomy. J Am Coll Surg 1999; 188:448-54. [PMID: 10195730 DOI: 10.1016/s1072-7515(99)00003-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J P Pierie
- Department of Surgery, University Hospital Utrecht, The Netherlands
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Forse RA, MacDonald PH, Mercer CD. Anastomotic and regional blood flow following esophagogastrectomy in an opossum model. J INVEST SURG 1999; 12:45-52. [PMID: 10084679 DOI: 10.1080/089419399272764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adenocarcinoma of the esophagus is increasing in incidence. The primary treatment is surgical resection, which is associated with considerable risk of anastomotic dehiscence and stricture. Decreased blood flow has been suggested as one of the factors contributing to these anastomotic failures. Our hypothesis was that anastomotic blood flow was decreased secondary to gastric and esophageal mobilization and would be increased by endogenous nitric oxide. Five opossums underwent esophagogastrectomy. Gastric and esophageal blood flow was measured following laparotomy, esophageal and gastric mobilization, esophagogastric resection and anastomosis, and L-arginine infusion. Radioactive microspheres were used to measure blood flow in the mucosa and muscularis of the esophagogastric anastomosis, esophagus, and stomach. Contrary to our hypothesis, blood flow in the anastomosis was maintained if not increased following esophagogastrectomy. However, the blood flow to the gastric mucosa adjacent to the anastomosis may be decreased. This suggests a possible redistribution of gastric blood flow to supply the anastomosis. If prolonged, this may contribute to poor anastomotic healing. L-Arginine infusion had no effect on blood flow at the anastomosis.
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Affiliation(s)
- R A Forse
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Urschel JD. Esophagogastric anastomotic leaks: the importance of gastric ischemia and therapeutic applications of gastric conditioning. J INVEST SURG 1998; 11:245-50. [PMID: 9788665 DOI: 10.3109/08941939809032198] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The etiology of esophagogastric anastomotic leaks is often multifactorial. However, occult ischemia of the gastric fundus is an important cause. In gastric conditioning, preliminary partial gastric devascularization is done 2-3 weeks before construction of the esophagogastric anastomoses. Gastric vascularity improves over this time. In animal studies, gastric conditioning has reduced the incidence of anastomotic leaks. Clinically, the concept of gastric conditioning can be used in several ways. Esophagectomy can be done at one stage, and then a cervical esophagogastric anastomosis can be completed as a second-stage procedure. Preesophagectomy angiographic gastric artery embolization is another method of gastric conditioning. Finally, laparoscopic partial gastric devascularization can be done at the time of laparoscopic cancer staging. For gastric conditioning to be clinically useful, the benefit from reduction in leaks must be greater than the costs and morbidity of the conditioning procedure itself.
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Affiliation(s)
- J D Urschel
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA
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40
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Abstract
BACKGROUND Esophagogastric anastomotic leaks continue to be a major source of morbidity and mortality after esophagectomy. Leaks usually result from technical errors or occult ischemia of the mobilized gastric fundus. The introduction of stapled esophagogastric anastomoses was initially very promising; leak rates appeared to be reduced. DATA SOURCES The English language medical literature was searched for publications comparing stapled and hand-sewn esophagogastric anastomoses. We reviewed data from four randomized trials and seven nonrandomized comparative studies to determine if stapling was superior to hand suturing for esophagogastric anastomoses. RESULTS Pooled data from randomized trials comparing stapled with hand-sewn esophagogastric anastomoses showed no significant difference for leaks (stapled 9%, hand-sewn 8%, P <0.67), but a higher incidence of strictures in stapled anastomoses (stapled 27%, hand-sewn 16%, P < 0.02). In nonrandomized studies, stapled anastomoses had a lower leak rate (stapled 6%, hand-sewn 11%, P < 0.0001), but strictures were more frequent (stapled 31%, hand-sewn 16%, P < 0.0001). A major source of bias in the nonrandomized studies was the comparison of contemporary stapled experience and earlier hand-sewn experience. This bias was not present in three of seven nonrandomized studies that featured prospective data collection. Pooled data from these three studies showed no difference in anastomotic leak rate (stapled 4%, hand-sewn 6%, P < 0.28). CONCLUSIONS Stapled and hand-sewn esophagogastric anastomotic techniques have equivalent anastomotic leak rates, but strictures are more common in stapled anastomoses. Irrespective of which technique is used, surgical experience and meticulous attention to detail are required to prevent anastomotic complications. Anastomotic technical modifications alone are unlikely to eliminate the problem of leaks, since they do not address the problem of gastric fundal ischemia.
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Affiliation(s)
- A L Beitler
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA
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Honkoop P, Siersema PD, Tilanus HW, Stassen LP, Hop WC, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 1996; 111:1141-6; discussion 1147-8. [PMID: 8642814 DOI: 10.1016/s0022-5223(96)70215-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Benign stricture formation at the cervical anastomosis after transhiatal esophagectomy with gastric tube interposition is an important source of morbidity. In a large group of patients (n = 269) who had undergone transhiatal esophagectomy with gastric tube interposition, we examined surgical and nonsurgical risk factors for the development of benign strictures at the cervical anastomosis. In addition, we evaluated the results of endoscopic bougie dilation in patients in whom an anastomotic stricture developed. RESULTS During follow-up, 114 patients (42%) had a benign anastomotic stricture. Only a history of cardiac disease (P = 0.03), postoperative leakage at the anastomosis (p = 0.002), and a stapled rather than a hand-sewn anastomosis (p = 0.04) were found to be independent risk factors for the development of a stricture. In 27 of 60 patients with anastomotic leakage, contrast swallow examination demonstrated only a leak at the anastomosis. Endoscopic bougie dilation of anastomotic strictures was successful in 78% of patients after a median of three dilation sessions (range 1 to 28). In 3% of patients dilations were still being performed, and 19% of patients had died before normal swallowing had been achieved. In two of 519 (0.4%) dilation sessions a major complication occurred. CONCLUSIONS (1) Patients with preoperative cardiac disease are at an increased risk for anastomotic stricture. (2) Even in patients having no symptoms, a contrast swallow can detect anastomotic leakage that results in an increased risk for the development of anastomotic strictures. (3) The benefit of the stapler device for anastomosis remains to be determined. (4) Endoscopic bougie dilation with the patient mildly sedated is a safe and effective method for the treatment of anastomotic strictures.
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Affiliation(s)
- P Honkoop
- Department of Internal Medicine II, Division of Gastroenterology, University Hospital Rotterdam-Dijkzigt, Rotterdam, The Netherlands
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Faller J. Surgery for esophageal and cardia cancer in Hungary: a nationwide retrospective five-year survey. Surg Today 1996; 26:368-72. [PMID: 8726625 DOI: 10.1007/bf00311610] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A nationwide retrospective 5-year survey was conducted, examining the surgical treatment of cancer of the esophagus and the esophagogastric junction in Hungary. The population of Hungary is at low risk of developing esophageal cancer, with an associated mortality rate of 5.84 per 100,000 in 1992. During the 5 years between 1988 and 1992, a total of 1197 resections were performed for cancer of the esophagus and cardia, with 817 for esophageal cancer (in the cervical area in 40, the upper and midthoracic areas in 436, and the lower third in 341), and 380 for cancer of the cardia. Most of the procedures were total or subtotal esophagectomy, performed in 629 patients, with the stomach being used for replacement of the esophagus in 555 (88.2%) patients, the right colon in 46 (7.3%) and the left colon in 28 (4.5%). Transhiatal blunt esophagectomy was performed in 264 patients, representing 22.0% of all resections. The overall leakage rate was 21%, occurring in 251 patients, and the overall mortality rate was 13.5%, or 162 patients. A very strong correlation existed between the experience of the departments where surgery was performed and the mortality rate.
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Affiliation(s)
- J Faller
- Surgical Department, St. John Hospital, Semmelweis University Medical School, Budapest, Hungary
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