Digestive Decompression to Prevent Digestive Fistulas After Gastric Neoplasm Resection

Introduction: The risk of digestive fistula in patients operated for gastric neoplasm is increased due to biological imbalances generated by the cancer's progression, by diagnosis in advanced stages, and by the scale of intervention. Under these circumstances the use of some technical means to protect digestive sutures in these patients is useful.

AIM

To analyse the efficiency of technical means to protect the digestive sutures in patients operated in various stages of development of gastric cancer. Material and Methods: We conducted a retrospective study on a group of 130 patients operated for gastric cancer in the 1st General Surgery and Oncology Clinic of the Bucharest Institute of Oncology, between 2010-2014. Results: 38.46% of the patients in the study group presented stage IV cancer with multiple complications and biological imbalances. 52 total gastrectomies and 40 gastric resections were carried out, while in 34 patients palliative "tumour excisions" or other types of palliative surgery were performed. In 15 of the cases with gastric resection a duodenal decompression probe was used, while in 13 of the patients with total gastrectomy an oeso-jejunal aspiration probe together with an oeso-jejunal feeding probe were used as additional technical measures to prevent fistula formation. The incidence of duodenal stump fistula was 7.69%, that of oeso-jejunal anastomosis fistula was 2.3%, with an overall mortality of 3.07% and that of gastro-jejunal anastomosis fistula was 0.76%.

CONCLUSION

Given the risk of fistula development in patients with gastric cancer, as well as the increased risk in advanced stages of cancer development, we consider that the use of technical means of protection of digestive sutures is beneficial and opportune, lowering the incidence of fistulas, reducing their output, pathophysiological effects, and mortality.

The use of gastrostomy procedures in HNC patients

PURPOSE

To analyse the gastrostomy procedures performed in HNC patients admitted to Coltea Clinical Hospital in order to underline the similarities and differences to the data published worldwide.

PATIENTS AND METHODS

Our retrospective study contains 64 HNC cases that met the inclusion criteria between 2008 and 2011.

RESULTS AND DISCUSSIONS

The study group presents numerous specific characteristics (a larger number of cases aged over 55 than younger patients; elective use of classic gastrostomy instead of newer techniques; approximately two thirds of the gastrostomies were performed in patients with laryngeal carcinoma; only one third approximately of the cases benefited from prophylactic gastrostomy; etc.).

CONCLUSIONS

22% of the gastrostomies were made after the appearance of a pharyngocutaneous fistula. Therefore we will begin a future prospective study in order to ascertain the value of prophylactic PEG in preventing the appearance of pharyngocutaneous fistulas.

Early oral feeding following total laryngectomy

INTRODUCTION

Pharyngocutaneous fistula is one of the most common nonfatal laryngectomy complications (7.6% to 65% of all total patients). Preoperative radiotherapy, advanced tumor stage, poor preoperative medical status, and concomitant pharyngectomy are usually accepted causative factors in fistula formation. Delay of oral feeding is a common practice used by head and neck surgeons to prevent the development of pharyngocutaneous fistula. In this article we analyze our experience with special emphasis given to the early start of postoperative feeding.

PATIENTS AND METHODS

The postoperative records of 48 patients who had undergone total laryngectomy or total laryngopharyngectomy were reviewed. All patients were orally fed with water and clear liquids on the first postoperative day. The patients were closely observed at every feeding attempt, and if any sign of fistula was noted, a nasogastric tube was inserted. Preoperative radiotherapy, stage of disease, tumor differentiation, and pharyngectomy with total laryngectomy were statistically analyzed as potential risk factors contributing to fistula formation. The Fisher exact test was used to analyze the data.

RESULTS

The overall pharyngocutaneous fistula rate was 12.5% in our series. The only statistically significant factor that increased the rate of fistula formation was resection of pharyngeal mucosa as an extension of total laryngectomy. Other parameters failed to show any statistical significance in development of this complication.

CONCLUSION

Evaluation of fistula incidence in our series indicates that initiating oral feeding on the first postoperative day does not contribute to fistula formation. Additionally, the relatively shortened hospital stay and elimination of the psychologic and traumatic side effects of tube feeding are benefits of this approach that should be studied in further prospective quality-of-life studies.