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Palleiko BA, Dickson KM, Crawford A, Shafique S, Emmerick I, Uy K, Maxfield MW, Lou F. Preoperative risk factors for anastomotic leak after esophagectomy with gastric reconstruction: A 6-year national surgical quality improvement (NSQIP) database analysis. Surgery 2024; 176:93-99. [PMID: 38719700 DOI: 10.1016/j.surg.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/26/2024] [Accepted: 03/21/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Anastomotic leak is a serious complication after esophagectomy that has been associated with worse outcomes. However, identifying patients at increased risk for anastomotic leak remains challenging. METHODS Patients were included from the 2016 to 2021 National Surgical Quality Improvement Project database who underwent elective esophagectomy with gastric reconstruction for cancer. A multivariable logistic regression model was used to identify risk factors associated with anastomotic leak. RESULTS A total of 4,331 patients were included in the study, of whom 647 patients experienced anastomotic leak (14.9%). Multivariable logistic regression revealed higher odds of anastomotic leak with smoking (adjusted odds ratio 1.24, confidence interval 1.02-1.51, P = .031), modified frailty index-5 score of 1 (adjusted odds ratio 1.44, confidence interval 1.19-1.75, P = .002) or 2 (adjusted odds ratio 1.52, confidence interval 1.19-1.94, P = .000), and a McKeown esophagectomy (adjusted odds ratio 1.44, confidence interval 1.16-1.80, P = .001). Each 1,000/μL increase in white blood cell count was associated with a 7% increase in odds of anastomotic leak (adjusted odds ratio 1.07, confidence interval 1.03-1.10, P = .0005). Higher platelet counts were slightly protective, and each 10,000/ μL increase in platelet count was associated with 2% reduced odds of anastomotic leak (adjusted odds ratio 0.98, confidence interval 0.97-0.99, P = .001). CONCLUSION In this study, smoking status, frailty index, white blood cell count, McKeown esophagectomy, and platelet counts were all associated with the occurrence of anastomotic leak. These results can help to inform surgeons and patients of the true risk of developing anastomotic leak and potentially improve outcomes by providing evidence to improve preoperative characteristics, such as frailty.
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Affiliation(s)
- Benjamin A Palleiko
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
| | - Kevin M Dickson
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Allison Crawford
- Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Samih Shafique
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Isabel Emmerick
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Karl Uy
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Mark W Maxfield
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Feiran Lou
- Department of Surgery, Division of Thoracic Surgery, University of Massachusetts Chan Medical School, Worcester, MA
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Rahouma M, Baudo M, Mynard N, Kamel M, Khan FM, Shmushkevich S, Mehta K, Hosny M, Dabsha A, Khairallah S, Demetres M, Saad R, Mohamed A, Port JL, Altorki NK, Gaudino M. Volume outcome relationship in postesophagectomy leak: a systematic review and meta-analysis. Int J Surg 2024; 110:2349-2354. [PMID: 37052430 PMCID: PMC11020050 DOI: 10.1097/js9.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Anastomotic leak after esophagectomy carries important short- and long-term sequelae. The authors conducted a systematic review and meta-analysis to determine its association with surgical volume. MATERIALS AND METHODS A systematic literature review was performed to identify all studies reporting on anastomotic leak after esophagectomy. Studies with less than 100 cases were excluded. The primary outcome was postesophagectomy anastomotic leak, while secondary outcomes were operative mortality overall and after anastomotic leak. Pooled event rates (PER) were calculated, and the association with annual esophagectomy volume by center was investigated. RESULTS Of the 3932 retrieved articles, 472 were included ( n =177 566 patients). The PER of anastomotic leak was 8.91% [95% CI=8.32; 9.53%]. The PER of early mortality overall and after an anastomotic leak was 2.49% [95% CI=2.27; 2.74] and 11.39% [95% CI=9.66; 13.39], respectively. Centers with less than 37 annual esophagectomies had a higher leak rate compared to those with greater than or equal to 37 annual esophagectomies (9.58% vs. 8.34%; P =0.040). On meta-regression, surgical volume was inversely associated with the PER of esophageal leak and of early mortality. CONCLUSIONS The frequency of anastomotic leaks after esophagectomy, perioperative, and leak associated mortality are inversely associated with esophagectomy volume.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
- Surgical Oncology Department, National Cancer Institute, Cairo University
| | - Massimo Baudo
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Nathan Mynard
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Mohamed Kamel
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
- Surgical Oncology Department, National Cancer Institute, Cairo University
| | - Faiza M. Khan
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Shon Shmushkevich
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Kritika Mehta
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Mohamed Hosny
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Anas Dabsha
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
- Surgical Oncology Department, National Cancer Institute, Cairo University
| | - Sherif Khairallah
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
- Surgical Oncology Department, National Cancer Institute, Cairo University
| | - Michelle Demetres
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, USA
| | - Reda Saad
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | | | - Jeffrey L. Port
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Nasser K. Altorki
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
| | - Mario Gaudino
- Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital
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Bao T, Chen P, Yu J, Cai DH, He XD, Wang YJ, Xie XF, Li KK, Zhao XY, Guo W. Learning curve in relation to health-related quality of life in long-term, disease free survivors after McKeown minimally invasive esophagectomy. Surg Endosc 2024; 38:671-678. [PMID: 38012442 DOI: 10.1007/s00464-023-10553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The potential impact of learning curve on long-term health-related quality of life (QoL) after esophagectomy for cancer has not been investigated. The aim of this article is to investigate the relationship between learning curve for McKeown minimally invasive esophagectomy (MIE) and health-related quality of life (QoL) in long-term, disease free survivors up to 10 years after esophageal cancer resection. METHODS Esophageal cancer patients who underwent McKeown MIE between 2009 and 2019 were identified in which 280 who were free of disease at the time of survey and completed health-related QoL and symptom questionnaires, including EORTC QLQ-C30, EORTC QLQ-OES18, and Digestive Symptom Questionnaire. Patients were assessed in 3 cohorts according to the learning phases of expertise reported by our previous study: initial phase; plateau phase, and; experienced phase. RESULTS Median time from operation to survey was 5.8 years (interquartile range 4.6-8.2). The QLQ-C30 mean scores of functional scales, and symptom scales of respiratory and digestive systems including dyspnea (P = 0.006), shortness of breath (P = 0.003), and dysphagia (P = 0.031) were significantly better in experienced phase group. Furthermore, in the subgroup analyses for patients without postoperative major complications, patients in the initial learning phase remained suffering from more symptoms of dyspnea (P = 0.040) and shortness of breath (P = 0.001). CONCLUSION Esophageal cancer patients undergoing McKeown MIE in initial learning phase tend to suffer from a deterioration in long-term health-related QoL and higher symptomatic burden as compared to experienced learning phase, which did not improved over time and warranted more attention.
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Affiliation(s)
- Tao Bao
- Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People's Republic of China
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ping Chen
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Jun Yu
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Dao-Hong Cai
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xian-Dong He
- Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People's Republic of China
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ying-Jian Wang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xian-Feng Xie
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Kun-Kun Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xiao-Ying Zhao
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wei Guo
- Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People's Republic of China.
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China.
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The impact of the 30-day postoperative complications on the quality of life following gastrectomy for gastric carcinoma: A prospective study. Eur J Surg Oncol 2023; 49:983-989. [PMID: 36682945 DOI: 10.1016/j.ejso.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of postoperative complications on long-term quality of life (QoL) is controversial in abdominal surgery. This study aimed to investigate the impact of 30-day postoperative complications on long-term QoL after gastrectomy. METHOD This is a longitudinal cohort study that enrolled 908 patients undergoing gastrectomy for gastric cancer between 2016 and 2017. QoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) generic cancer (QLQ C-30) and gastric module (STO-22) preoperatively and at 1, 6, 12, and 24 months postoperatively. Patients were divided into the morbidity (30-day postoperative complications) and no-morbidity groups, and the postoperative QoL change was compared using a linear mixed model. RESULTS The mean age was 62.5 ± 12.0 years. Subtotal and total gastrectomy was performed in 763 (84.0%) and 145 (16.0%) patients, respectively. There were 189 (20.8%) patients developing postoperative complications. The morbidity group showed worse scores in several functions and symptoms of QoL at the baseline. However, the two groups showed no significant difference in postoperative changes in most functions and symptoms of the QLQ C-30 and STO-22 (Pgroup × time > 0.05). The recovery of global health (Pgroup × time < 0.001) and anxiety (Pgroup × time = 0.008) was slightly better in the morbidity group. The subgroup analysis of patients developing major abdominal complications showed similar results. CONCLUSION The morbidity group showed worse QoL in several functions and symptoms at the baseline. However, postoperative complications had little influence on QoL change following gastrectomy for gastric cancer.
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Jezerskyte E, van Berge Henegouwen MI, Sprangers MAG, Gisbertz SS. ASO Author Reflections: Postoperative Complications are not Associated with Decreased Health-Related Quality of Life in Patients Following Esophagectomy for Esophageal or Gastroesophageal Junction Cancer. Ann Surg Oncol 2021; 28:7277-7278. [PMID: 34089106 PMCID: PMC8519846 DOI: 10.1245/s10434-021-10234-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Egle Jezerskyte
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Functional syndromes and symptom-orientated aftercare after esophagectomy. Langenbecks Arch Surg 2021; 406:2249-2261. [PMID: 34036407 PMCID: PMC8578083 DOI: 10.1007/s00423-021-02203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/16/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Surgery is the cornerstone of esophageal cancer treatment but remains burdened with significant postoperative changes of gastrointestinal function and quality of life. PURPOSE The aim of this narrative review is to assess and summarize the current knowledge on postoperative functional syndromes and quality of life after esophagectomy for cancer, and to provide orientation for the reader in the challenging field of functional aftercare. CONCLUSIONS Post-esophagectomy syndromes include various conditions such as dysphagia, reflux, delayed gastric emptying, dumping syndrome, weight loss, and chronic diarrhea. Clinical pictures and individual expressions are highly variable and may be extremely distressing for those affected. Therefore, in addition to a mostly well-coordinated oncological follow-up, we strongly emphasize the need for regular monitoring of physical well-being and gastrointestinal function. The prerequisite for an effective functional aftercare covering the whole spectrum of postoperative syndromes is a comprehensive knowledge of the pathophysiological background. As functional conditions often require a complex diagnostic workup and long-term therapy, close interdisciplinary cooperation with radiologists, gastroenterologists, oncologists, and specialized nutritional counseling is imperative for successful management.
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Jezerskyte E, van Berge Henegouwen MI, van Laarhoven HWM, van Kleef JJ, Eshuis WJ, Heisterkamp J, Hartgrink HH, Rosman C, van Hillegersberg R, Hulshof MCCM, Sprangers MAG, Gisbertz SS. Postoperative Complications and Long-Term Quality of Life After Multimodality Treatment for Esophageal Cancer: An Analysis of the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). Ann Surg Oncol 2021; 28:7259-7276. [PMID: 34036429 PMCID: PMC8519926 DOI: 10.1245/s10434-021-10144-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Esophagectomy has major effects on health-related quality of life (HR-QoL). Postoperative complications might contribute to a decreased HR-QOL. This population-based study aimed to investigate the difference in HR-QoL between patients with and without complications after esophagectomy for cancer. METHODS A prospective comparative cohort study was performed with data from the Netherlands Cancer Registry (NCR) and Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). All patients with esophageal and gastroesophageal junction (GEJ) cancer after esophagectomy in the period 2015-2018 were enrolled. The study investigated HR-QoL at baseline, then 3, 6, 9, 12, 18, and 24 months postoperatively, comparing patients with and without complications as well as with and without anastomotic leakage. RESULTS The 486 enrolled patients comprised 270 patients with complications and 216 patients without complications. Significantly more patients with complications had comorbidities (69.6% vs 57.3%; p = 0.001). No significant difference in HR-QoL was found over time between the patients with and without complications. In both groups, a significant decline in short-term HR-QoL was found in various HR-QoL domains, which were restored to the baseline level during the 12-month follow-up period. No significant difference was found in HR-QoL between the patients with and without anastomotic leakage. The patients with grades 2 and 3 anastomotic leakage reported significantly more "choking when swallowing" at 6 months (ß = 14.5; 95% confidence interval [CI], - 24.833 to - 4.202; p = 0.049), 9 months (ß = 22.4, 95% CI, - 34.259 to - 10.591; p = 0.007), and 24 months (ß = 24.6; 95% CI, - 39.494 to - 9.727; p = 0.007) than the patients with grade 1 or no anastomotic leakage. CONCLUSION In general, postoperative complications were not associated with decreased short- or long-term HR-QoL for patients after esophagectomy for esophageal or GEJ cancer. The temporary decrease in HR-QoL likely is related to the nature of esophagectomy and reconstruction itself.
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Affiliation(s)
- E Jezerskyte
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Amsterdam UMC, Department of Medical Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J J van Kleef
- Amsterdam UMC, Department of Medical Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - W J Eshuis
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J Heisterkamp
- Department of Surgery, Embraze Comprehensive Cancer Network, Elisabeth- Tweesteden Hospital, Tilburg, The Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - C Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C C M Hulshof
- Amsterdam UMC, Department of Radiotherapy, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M A G Sprangers
- Amsterdam UMC, Department of Medical Psychology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Amsterdam UMC, Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
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El-Ahmar M, Koch F, Gabrielian D, Mudter J, Ritz JP. [Esophageal cancer leading to a cerebral infarction]. Chirurg 2021; 92:264-268. [PMID: 32965522 DOI: 10.1007/s00104-020-01260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mohamad El-Ahmar
- Helios Kliniken Schwerin, Wismarsche Str. 393-397, 19055, Schwerin, Deutschland.
| | - Franziska Koch
- Helios Kliniken Schwerin, Wismarsche Str. 393-397, 19055, Schwerin, Deutschland
| | - Davit Gabrielian
- Helios Kliniken Schwerin, Wismarsche Str. 393-397, 19055, Schwerin, Deutschland.,Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen am Rhein, Deutschland
| | - Jonas Mudter
- Helios Kliniken Schwerin, Wismarsche Str. 393-397, 19055, Schwerin, Deutschland
| | - Jörg-Peter Ritz
- Helios Kliniken Schwerin, Wismarsche Str. 393-397, 19055, Schwerin, Deutschland
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Hedberg J, Linder G, Sundbom M. Peri-anastomotic microdialysis lactate assessment after esophagectomy. Esophagus 2021; 18:783-789. [PMID: 34052933 PMCID: PMC8387264 DOI: 10.1007/s10388-021-00846-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Esophagectomy is the cornerstone in curative treatment for esophageal and gastroesophageal junctional cancer. Esophageal resection is an advanced procedure with many complications, whereof anastomotic leak is the most dreaded. This study aimed to monitor the microcirculation with microdialysis analysis of local lactate levels in real-time on both sides of the esophagogastric anastomosis in totally minimally invasive Ivor-Lewis esophagectomy. MATERIALS AND METHODS Twenty-five patients planned for esophageal resection with gastric conduit reconstruction and intrathoracic anastomosis were recruited. A sampling device, the OnZurf® Probe, along with the CliniSenz® Analyser (Senzime AB, Uppsala Sweden) was utilized for measurements. Lactate levels from both sides of the anastomosis were analysed in real time, on site, by a transportable analyser device. Measurements were made every 30 min during the first 24 h, and thereafter every 2 hours for up to 4 days. RESULTS All probes could be positioned as planned and on the third postoperative day 19/25 and 15/25 of the esophageal and gastric probes, respectively, continued to deliver measurements. In total, 89.6% (1539/1718) and 72.4% (1098/1516) of the measurements were deemed successful. The average lactate level on the esophageal side of the anastomosis and the gastric conduit ranged between 1.1-11.5 and 0.8-7.0 mM, respectively. Two anastomotic leaks occurred, one of which had persisting high lactate levels on the gastric side of the anastomosis. CONCLUSION Application and use of the novel CliniSenz® analyser system, in combination with the OnZurf® Probe was feasible and safe. Continuous monitoring of analytes from the perianastomotic area has the potential to improve care after esophageal resection.
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Affiliation(s)
- Jakob Hedberg
- Department of Surgical Sciences, Uppsala University, 75185 Akademiska Sjukhuset, Uppsala, Sweden
| | - Gustav Linder
- Department of Surgical Sciences, Uppsala University, 75185 Akademiska Sjukhuset, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, 75185 Akademiska Sjukhuset, Uppsala, Sweden
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Yoshida K, Tanaka Y, Imai T, Sato Y, Hatanaka Y, Suetsugu T, Okumura N, Matsuhashi N, Takahashi T, Yamaguchi K. Subtotal stomach in esophageal reconstruction surgery achieves an anastomotic leakage rate of less than 1%. Ann Gastroenterol Surg 2020; 4:422-432. [PMID: 32724886 PMCID: PMC7382430 DOI: 10.1002/ags3.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 11/18/2022] Open
Abstract
Aim The objective of this retrospective, single‐institution study was to assess the safety and feasibility of reconstruction using subtotal stomach (SS) with esophagectomy for patients with esophageal cancer (EC). Although several different gastric‐tube‐making and anastomotic methods have been reported, the incidence rate of anastomotic leakage with EC surgery is generally reported over 10%. Complications should be avoided, and patient quality of life (QOL) should be maintained postoperatively. We have used SS reconstruction and hand‐sutured cervical esophagus‐subtotal gastric anastomosis at the neck wound in EC surgery. Short‐ and long‐term outcomes in cases using SS are not well known. Methods Between January 2008 and September 2019, 300 patients underwent esophagectomy for EC and reconstruction using SS. The primary endpoint was the rate of anastomotic leakage. Secondary endpoints were postoperative morbidities, QOL, and changes in patients’ body weight and skeletal muscle weight. Results Anastomotic leakage was observed in two patients (0.67%), and pneumonia was observed in nine patients (3.0%). Fifteen patients (5.0%) had an anastomotic stenosis requiring a bougie. Nausea occurred in 11 patients (3.7%), and dumping syndrome occurred in seven patients (2.3%). Dysphagia and early feeling of abdominal fullness scores tended to be high after surgery but gradually decreased after 6 months. Good results were obtained for reflux feeling scores. Body weight changed with an average decrease of −2 ± 3.71 kg (P = .071) over 5 years. Conclusion Reconstruction using SS resulted in an extremely low rate of anastomotic leakage and good QOL postoperatively in patients with EC.
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Affiliation(s)
- Kazuhiro Yoshida
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Takeharu Imai
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Yuta Sato
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Yuji Hatanaka
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Tomonari Suetsugu
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Naoki Okumura
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Takao Takahashi
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
| | - Kazuya Yamaguchi
- Department of Surgical Oncology Graduate School of Medicine Gifu University Gifu Japan
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Postoperative Complications and Health-related Quality of Life 10 Years After Esophageal Cancer Surgery. Ann Surg 2020; 271:311-316. [PMID: 29995688 DOI: 10.1097/sla.0000000000002972] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of postoperative complications on health-related quality of life (HRQOL) up to 10 years after surgery for esophageal cancer. BACKGROUND The impact of postoperative complications on HRQOL past 5 years is unknown. METHODS Some 616 patients undergoing open esophageal cancer surgery between April 2, 2001 and December 31, 2005 in Sweden were enrolled in this population-based, nationwide, and prospective cohort study. Exposure was the occurrence of predefined postoperative complications, and the outcome was HRQOL evaluated by validated European Organization for Research and Treatment of Cancer questionnaires at 6 months, 3, 5, and 10 years after surgery. Linear mixed models, adjusted for longitudinal HRQOL in the general population and confounders, provided mean score differences (MDs) with 95% confidence intervals (CIs) for each HRQOL item and scale in patients with or without postoperative complications. RESULTS At 10 years, 104 (17%) patients were alive and 92 (88%) answered the HRQOL questionnaires. Of these, 37 (40%) had at least 1 predefined postoperative complication. Twelve of the 25 scales and items were significantly worse in patients with postoperative complications 10 years after surgery, for example, physical function (MD -15, 95% CI -24 to -7), fatigue (MD 16, 95% CI 5-26), pain (MD 18, 95% CI 7-30), dyspnea (MD 15, 95% CI 2-27), insomnia (MD 20, 95% CI 8-32), and eating problems (MD 14, 95% CI 3-24) compared to patients without complications. CONCLUSIONS Postoperative complications are associated with considerably impaired HRQOL up to 10 years after esophageal cancer surgery.
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12
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Medical and Surgical Complications and Health-related Quality of Life After Esophageal Cancer Surgery. Ann Surg 2020; 271:502-508. [DOI: 10.1097/sla.0000000000003097] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Manghelli JL, Ceppa DP, Greenberg JW, Blitzer D, Hicks A, Rieger KM, Birdas TJ. Management of anastomotic leaks following esophagectomy: when to intervene? J Thorac Dis 2019; 11:131-137. [PMID: 30863581 DOI: 10.21037/jtd.2018.12.13] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Esophagectomy is the mainstay treatment for early stage and locoregionally advanced esophageal cancer. Anastomotic leaks following esophagectomy are associated with numerous detrimental sequelae. The management of anastomotic leaks has evolved over time. The present study is a single-institution experience of esophageal leak management over an 11-year period, in order to identify when these can be managed nonoperatively. Methods All patients undergoing esophagectomy with gastric reconstruction at our institution between 2004 and 2014 were identified. Preoperative patient characteristics and perioperative factors were reviewed. Failure of initial leak treatment was defined as need for escalation of therapy. Length of stay (LOS) and postoperative mortality were the primary outcomes. Follow-up was obtained through institutional medical records and the Social Security Death Index. Results Sixty-one of 692 (8.8%) patients developed an anastomotic leak. Forty-six patients (75.4%) first underwent observation, which was successful in 35 patients. Predictors of successful observation included higher preoperative albumin (P=0.02), leak diagnosed by esophagram (P=0.004), and contained leaks (P=0.01). Successful observation was associated with shorter LOS (P=0.001). Predictors of mortality included lower preoperative serum albumin (P=0.01) and induction therapy (P=0.03). Thirty and 90-day mortality among patients who developed an anastomotic leak were 9.8% and 16.7%, respectively. Conclusions Over half of anastomotic leaks were managed successfully with observation alone and did not require additional interventions. We have identified factors that may predict successful therapy with observation in these patients. Further research is warranted to determine more timely interventions for patients likely to fail conservative management.
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Affiliation(s)
- Joshua L Manghelli
- Division of General Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
| | - DuyKhanh P Ceppa
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
| | - Jason W Greenberg
- Division of General Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
| | - David Blitzer
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
| | - Adam Hicks
- Division of General Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
| | - Karen M Rieger
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
| | - Thomas J Birdas
- Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
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Hagens ERC, Anderegg MCJ, van Berge Henegouwen MI, Gisbertz SS. International Survey on the Management of Anastomotic Leakage After Esophageal Resection. Ann Thorac Surg 2018; 106:1702-1708. [PMID: 29883644 DOI: 10.1016/j.athoracsur.2018.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anastomotic leakage is one of the most severe complications following esophageal surgery, leading to significant morbidity, prolonged hospital stay, considerable costs, decreased quality of life, and increased mortality. Management of anastomotic leakage is complicated and has currently not been standardized. The objective of this research is to gain insight into the different opinions on anastomotic leakage management among upper gastrointestinal surgeons and verify the need for diagnostic and treatment guidelines. METHODS Surgeons with interest in esophageal surgery were invited to participate in an international online questionnaire. The survey consisted of questions pertaining to the surgeons' experience, operation techniques, management routine, and opinion on future international guidelines on the treatment of anastomotic leakage. RESULTS Of the 331 invited surgeons, 40% participated in the survey. Among the 129 responders, 90.7% use laboratory diagnostics and 62.8% use imaging or endoscopy postoperatively on a routine basis to detect anastomotic leakage. In case of suspected anastomotic leakage, the most chosen diagnostic imaging modalities were computed tomography scan (35.7%) or dynamic swallow investigation (33.3%). Independent from the clinical manifestations, participants of this survey treat patients very differently. More than 70% of the responders agreed that there is a need for diagnostic and therapeutic international guidelines on anastomotic leakage management. CONCLUSIONS This survey shows that there is no standardized guideline for diagnostic workup or management of anastomotic leakage and that there is a need for an international guideline regarding the optimal management of anastomotic leakage.
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Affiliation(s)
- Eliza R C Hagens
- Department of Surgery, Academic Medical Center and Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Maarten C J Anderegg
- Department of Surgery, Academic Medical Center and Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center and Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Dent B, Griffin SM, Jones R, Wahed S, Immanuel A, Hayes N. Management and outcomes of anastomotic leaks after oesophagectomy. Br J Surg 2016; 103:1033-8. [PMID: 27146631 DOI: 10.1002/bjs.10175] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/02/2015] [Accepted: 02/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Leaks following oesophagectomy include true anastomotic leaks, leaks from the gastrotomy and gastric conduit necrosis. Historically, these complications were associated with high mortality rates. Recent improvements in outcome have been attributed to the wider use of oesophageal stents in patient management. This study examined outcomes of patients who developed a leak in a single high-volume institution that did not use stenting as a primary treatment modality. METHODS All patients undergoing an oesophagectomy between January 2009 and December 2013 were included. Patients were identified from a prospectively maintained database. RESULTS A total of 390 oesophagectomies were performed (median age 65 (range 32-81) years). In 96·7 per cent of patients this was a two-stage subtotal oesophagectomy. Overall in-hospital and 90-day mortality rates were both 2·1 per cent (8 patients). Some 31 patients (7·9 per cent) developed a leak (median age 64·5 (range 52-80) years), of whom 27 (87 per cent) were initially managed without surgery, whereas four (13 per cent) required immediate thoracotomy. The median length of stay for patients with a leak was 41·5 (range 15-159) days; none of these patients died. CONCLUSION Leaks can be managed with excellent outcomes without using oesophageal stents. The results do not support the widespread adoption of endoscopic stenting.
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Affiliation(s)
- B Dent
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - S M Griffin
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - R Jones
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - S Wahed
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - A Immanuel
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - N Hayes
- Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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16
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Weledji EP, Verla V. Failure to rescue patients from early critical complications of oesophagogastric cancer surgery. Ann Med Surg (Lond) 2016; 7:34-41. [PMID: 27054032 PMCID: PMC4802398 DOI: 10.1016/j.amsu.2016.02.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/20/2016] [Accepted: 02/28/2016] [Indexed: 02/06/2023] Open
Abstract
'Failure to rescue' is a significant cause of mortality in gastrointestinal surgery. Differences in mortality between high and low-volume hospitals are not associated with large difference in complication rates but to the ability of the hospital to effectively rescue patients from the complications. We reviewed the critical complications following surgery for oesophageal and gastric cancer, their prevention and reasons for failure to rescue. Strategies focussing on perioperative optimization, the timely recognition and management of complications may be essential to improving outcome in low-volume hospitals.
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Affiliation(s)
- Elroy P. Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Vincent Verla
- Department of Anaesthesia, Faculty of Health Sciences, University of Buea, Cameroon
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17
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Qiu B, Feng F, Gao S. Partial esophagogastrostomy with esophagogastric anastomosis below the aortic arch in cardiac carcinoma: characteristics and treatment of postoperative anastomotic leakage. J Thorac Dis 2015; 7:1994-2002. [PMID: 26716038 DOI: 10.3978/j.issn.2072-1439.2015.11.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Anastomotic leakage is a severe and common complication for surgeries of cardiac cancer. Here we explore the clinical features, diagnosis, and treatment strategies of anastomotic leakage in cardiac carcinoma patients after esophagogastric anastomosis. METHODS From January 2009 to December 2013, 1,196 patients with cardiac carcinoma underwent esophagectomy and esophagogastric anastomosis in Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences. Of them, 25 patients developed symptomatic anastomotic leakage. Their clinical data were retrospectively reviewed. RESULTS Among these 25 patients with anastomotic leakage, three died after active treatment and fifteen healed with thoracic drainage time 18-115 days. The left seven patients who did not heal until discharge developed chronic infection sinus of anastomotic leakage. Without infection symptoms, they were discharged 30-100 days after surgery with nasoenteral tube and thoracic drainage. CONCLUSIONS Anastomotic leakage in cardiac carcinoma patients after esophagogastric anastomosis can be classified into five subtypes: occult type, left thoracic type, right thoracic type, mediastinal type, and mixd type. Subtyping of anastomotic leakage is useful and convenient for diagnosis and treatment.
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Affiliation(s)
- Bin Qiu
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Feiyue Feng
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China
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Indocyanine Green Fluorescence Angiography for Quantitative Evaluation of Gastric Tube Perfusion in Patients Undergoing Esophagectomy. J Am Coll Surg 2015. [PMID: 26206660 DOI: 10.1016/j.jamcollsurg.2015.04.022] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Doorakkers E, Konings P, Mattsson F, Lagergren J, Brusselaers N. Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation: a prospective population-based cohort study. PLoS One 2015; 10:e0121080. [PMID: 25768921 PMCID: PMC4358940 DOI: 10.1371/journal.pone.0121080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/28/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period. METHODS This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively. CONCLUSION This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.
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Affiliation(s)
- Eva Doorakkers
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter Konings
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Division of Cancer Studies, King’s College London, London, United Kingdom
| | - Nele Brusselaers
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Schaheen L, Blackmon SH, Nason KS. Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review. Am J Surg 2014; 208:536-43. [PMID: 25151186 DOI: 10.1016/j.amjsurg.2014.05.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/10/2014] [Accepted: 05/20/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recently, endoscopic interventions (eg, esophageal stenting) have been successfully used for the management of intrathoracic leak. The purpose of this systematic review was to assess the safety and efficacy of techniques used in the management of intrathoracic anastomotic leak. DATA SOURCES We performed a systematic review of MEDLINE, EMBASE, and PubMed to identify eligible studies analyzing management of intrathoracic esophageal leak following esophagectomy. CONCLUSIONS Intraoperative anastomotic drain placement was associated with earlier identification and resolution of anastomotic leak (mean 23.4 vs 80.7 days). In addition, reinforcement of the anastomosis with omentoplasty may reduce the incidence of anastomotic leak by nearly 50%. Endoscopic stent placement was associated with leak resolution in 72%; fatal complications were reported, however, and safety remains to be proven. Negative pressure therapy, a potentially useful tool, requires further study. If stenting and wound vacuum are used, undrained mediastinal contamination and persistent leak require surgical intervention.
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Affiliation(s)
- Lara Schaheen
- Division of Thoracic and Foregut Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shanda H Blackmon
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Katie S Nason
- Division of Thoracic and Foregut Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Clinical application of mucosal valve technique for anastomosis during esophagogastrostomy. J Gastrointest Surg 2013; 17:2051-8. [PMID: 24135987 DOI: 10.1007/s11605-013-2382-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 10/01/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The study aims to compare the efficacy in prevention of anastomotic complications using layer-to-layer mucosal valve technique versus circular stapled technique for esophagogastric intrathoracic anastomosis after resection for esophageal and gastric cardiac carcinoma. METHODS From January 2005 to December 2010, 136 patients received layer-to-layer mucosal valve technique (LM group), 219 received circular stapled anastomosis (CS group) after curative intent resection for esophageal and gastric cardiac carcinoma. The technique details were reported and the clinical results were analyzed. RESULTS The two groups were comparable on clinical baseline characteristics. The average duration of operation was longer with LM technique by 16 min, but without statistical significance (P = 0.073). There was no anastomotic leakage in the LM group, while in the CS group, leakage occurred in seven patients (3.2 %, P = 0.047). Both the incidence and grade of postoperative dysphagia were significantly lower in the LM group (P < 0.05). Significantly fewer patients experienced stricture after LM technique (3.8 %) compared with CS anastomosis (18.2 %, P < 0.001). CS anastomosis was associated with a significantly higher incidence of persistent stricture requiring more dilatation (P < 0.001). Symptoms of reflux were better controlled by LM technique; 82.7 % of patients were asymptomatic with respect to reflux compared to 58.9 % in the CS group, P < 0.001. And there was a significant reduction in the incidence of esophagitis in remnant esophagus in the LM group (P = 0.001). CONCLUSIONS The layered mucosal valve anastomosis could significantly diminish the incidence of anastomotic complications and could be used as an alternative for esophagogastric anastomosis after resection of esophageal and gastric cardiac carcinoma.
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Sepesi B, Swisher SG, Walsh GL, Correa A, Mehran RJ, Rice D, Roth J, Vaporciyan A, Hofstetter WL. Omental reinforcement of the thoracic esophagogastric anastomosis: An analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy. J Thorac Cardiovasc Surg 2012; 144:1146-50. [DOI: 10.1016/j.jtcvs.2012.07.085] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/11/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022]
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