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You J, Zhang H, Li W, Dai N, Lu B, Ji Z, Zhuang H, Zheng Z. Intrathoracic versus cervical anastomosis in esophagectomy for esophageal cancer: A meta-analysis of randomized controlled trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022. [DOI: 10.1016/j.ejso.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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2
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You J, Zhang H, Li W, Dai N, Lu B, Ji Z, Zhuang H, Zheng Z. Intrathoracic versus cervical anastomosis in esophagectomy for esophageal cancer: A meta-analysis of randomized controlled trials. Surgery 2022; 172:575-583. [DOI: 10.1016/j.surg.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 01/19/2023]
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Gao HJ, Mu JW, Pan WM, Brock M, Wang ML, Han B, Ma K. Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short-term outcomes. Thorac Cancer 2020; 11:769-776. [PMID: 32012474 PMCID: PMC7049498 DOI: 10.1111/1759-7714.13339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anastomosis is one of the important factors affecting anastomotic complications after esophagectomy, and multiple reports have compared anastomotic complications among various techniques. However, there is insufficient evidence in the literature to definitively recommend one anastomotic technique over another. METHOD We retrospectively evaluated 34 consecutive patients who underwent an improved totally mechanical side-to-side: posterior-to-posterior linear stapled (TM-STS) technique for minimally invasive Ivor Lewis esophagogastric anastomosis, performed by a single surgeon between February 2015 to November 2017. The operative techniques and short-term outcomes are analyzed in this study. RESULTS There were no conversions to an open approach and a complete resection was achieved in all patients undergoing this improved procedure. During the first half of the series, the median operation time was 355 minutes, ranging from 257 to 480 minutes. Over the second half of this series, the median operation time was reduced to 256 minutes. There were no mortalities or serious postoperative complications. Only one patient (2.9%) had an anastomotic leak, which resolved without intervention. Another patient (2.9%) experienced transient, delayed conduit emptying which upper gastrointestinal radiography determined was due to a mechanical obstruction caused by an abnormally long gastric tube in the chest cavity. CONCLUSIONS The results of our study suggest that this improved TM-STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma.
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Affiliation(s)
- Hui-Jiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ju-Wei Mu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wei-Min Pan
- Department of Anesthesia, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Malcolm Brock
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mao-Long Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Han
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Ma
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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Nakahara Y, Yamasaki M, Miyazaki Y, Tanaka K, Makino T, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y. Reflux after esophagectomy with gastric conduit reconstruction in the posterior mediastinum for esophageal cancer: original questionnaire and EORTC QLQ-C30 survey. Dis Esophagus 2018; 31:4956131. [PMID: 29617733 DOI: 10.1093/dote/doy001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 12/11/2022]
Abstract
Reflux following an esophagectomy with gastric conduit reconstruction in the posterior mediastinum is a clinically significant problem. In this study, we investigated the frequency and impact of reflux on the quality of life (QOL) among 158 patients who underwent an esophagectomy for esophageal cancer using an original questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 (EORTC QLQ-C30). Reflux frequency was assessed using the original questionnaire. The number of patients who complained of reflux every day, two or three times a week, once a week, or less than once a week was 16 (10.1%), 21 (13.3%), 26 (16.5%), and 60 (38.0%), respectively. Out of 35 patients (22.2%) reported no reflux symptoms. Patients were divided into two groups: those with reflux ≥ once/week (63 patients) and those with low frequency of symptoms (95 patients). Time elapsed following surgery was the only factor to influence reflux frequency. Reflux frequency decreased within two years of surgery; however, the frequency plateaued after more than two years. QOL was assessed using the EORTC QLQ-C30. The ≥ once/week reflux group had a significantly lower global health status score than the low-frequency reflux group (59.6 ± 24.2 vs. 70.8 ± 20.7; P = 0.007). In addition, the ≥ once/week reflux group had a significantly lower social functioning score than the low-frequency reflux group (81.6 ± 24.1 vs. 88.4 ± 19.8; P = 0.035). Regarding symptoms, the ≥ once/week reflux group had significantly higher scores for fatigue, nausea, and vomiting, dyspnea and insomnia compared to the low-frequency reflux group (fatigue: 42.4 ± 21.9 vs. 28.9 ± 18.4, P < 0.001; nausea and vomiting: 17.3 ± 17.1 vs. 4.9 ± 10.6, P < 0. 001; dyspnea: 29.2 ± 26.0 vs. 21.7 ± 26.8, P = 0.043; insomnia: 22.2 ± 31.1 vs. 10.5 ± 21.7, P = 0.015). Thus, reflux after an esophagectomy was associated with a lower QOL.
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Affiliation(s)
- Y Nakahara
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita.,Department of Surgery, Kinki Central Hospital, Itami, Japan
| | - M Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - Y Miyazaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - K Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - T Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - T Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - Y Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - K Nakajima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - S Takiguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - M Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita
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5
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Kim D, Min YW, Park JG, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ, Zo JI. Influence of esophagectomy on the gastroesophageal reflux in patients with esophageal cancer. Dis Esophagus 2017; 30:1-7. [PMID: 28881892 DOI: 10.1093/dote/dox106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/26/2017] [Indexed: 12/11/2022]
Abstract
This study aims to assess the influence of esophagectomy with gastric transposition on the gastroesophageal reflux (GER) and gastric acidity in patients with esophageal cancer. Data on 53 esophageal cancer patients who underwent 24-hour impedance-pH monitoring after esophagectomy were retrospectively analyzed. We used a solid-state esophageal pH probe in which the esophageal pH sensor is placed 1.5 cm distal to the upper esophageal sphincter and the gastric pH sensor is located 15 cm distal to the esophageal pH channel. 24-hour impedance-pH monitoring data and other clinical data including anastomosis site stricture and incidence of pneumonia were collected. We defined pathologic reflux with reference to known normative data. Stricture was defined when an intervention such as bougienage or balloon dilatation was required to relieve dysphagia. The esophageal and gastric mean pH were 5.47 ± 1.51 and 3.33 ± 1.64, respectively. The percent time of acidic pH (<4) was 6.66 ± 12.49% in the esophagus and 70.53 ± 32.19% in the stomach. Esophageal pathologic acid reflux was noticed in 32.1%, 20.8%, and 35.8% during total, upright, and recumbent time, respectively. Esophageal pathologic bolus reflux was noted in 83.0%, 77.4%, and 64.2% during total, upright, and recumbent time, respectively. Gastric acidity increased with time after esophagectomy. Esophageal acid exposure time correlated with intragastric pH. However, esophageal pathologic acid reflux was not associated with anastomosis site stricture or pneumonia. In conclusion, GER frequently occurs after esophagectomy. Thus, strict lifestyle modifications and acid suppression would be necessary in patients following esophagectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - J I Zo
- Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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6
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Chen CY, Hsieh VCR, Chang CH, Chen PR, Liang WM, Pan SC, Shieh SH. Impacts of treatments on the quality of life among esophageal squamous cell carcinoma patients. Dis Esophagus 2017; 30:1-8. [PMID: 28859389 DOI: 10.1093/dote/dox061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/18/2017] [Indexed: 12/11/2022]
Abstract
This study aims to investigate the effects of treatments on the quality of life for patients with esophageal squamous cell carcinoma patients diagnosed at early and late stages. From a medical center in central Taiwan, patients who had been diagnosed with esophageal squamous cell carcinoma from February 2007 and March 2011 were recruited. Using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Quality of Life Questionnaire Oesophageal 18 (QLQ-OES18), quality of life scores for 105 esophageal squamous cell carcinoma patients were obtained and assessed. Multivariate analysis was performed on the quality of life scores after stratification by cancer stage. Among early-stage esophageal squamous cell carcinoma patients, those received only surgery (S-only) performed better in physical and social functioning compared with patients who underwent surgery and concurrent chemoradiotherapy (S+CCRT) (β = 9.0, P = 0.03; β = 12.1, P = 0.04, respectively). For those that received only concurrent chemoradiotherapy (CCRT-only), they performed worse in role and emotional functioning relative to S+CCRT patients (β = -17.2, P = 0.02; β = -15.7, P = 0.05, respectively). Among late-stage patients, CCRT-only treatment gave insignificantly better global health status and functional scale scores and less severe symptoms compared to the S+CCRT option. Better functional scores and less aggravated symptoms are observed in early-stage esophageal squamous cell carcinoma patients who received surgery-only treatment relative to those that underwent both surgery and chemoradiotherapy. For late-stage esophageal cancer patients, the measured difference of quality of life is not significant between CCRT-only and S+CCRT treatments.
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Affiliation(s)
- C-Y Chen
- Institute of Medicine, Department of Surgery, Chung Shan Medical University, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - V C-R Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - C-H Chang
- Department of Physical Medicine and Rehabilitation, and the Beuhler Center on Aging, Health & Society, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Rehabilitation Institute of Chicago, Chicago, Illinois, USA
| | - P-R Chen
- Division of Thoracic Surgery, China Medical University and Hospital, Taichung, Taiwan
| | - W-M Liang
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - S-C Pan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - S-H Shieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taiwan
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7
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Wu G, Yin M, Zhao YS, Fang Y, Zhao G, Zhao J, Han X. Novel esophageal stent for treatment of cervical anastomotic leakage after esophagectomy. Surg Endosc 2017; 31:5024-5031. [PMID: 28432462 DOI: 10.1007/s00464-017-5545-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dedicated stents for treatment of cervical anastomotic leakage are currently unavailable. In this study, we aimed to assess the feasibility and efficacy of using custom-designed stents for treatment of cervical anastomotic leakage after esophagectomy. METHODS The stents were designed according to the location and size of the leakage and the residual esophageal length as determined by esophagography in each case. It had a cup-shaped upper end and a globular lower end and a total height of 60-85 mm. The diameter of the upper cup-shaped part was 24-26 mm and the length 20-25 mm. The cup part and the stent main body were connected at a right angle. Data from cervical anastomotic leakage patients treated with these stents were retrospectively analyzed. RESULTS Data from a total of 27 patients with cervical anastomotic leakage were retrospectively analyzed. The custom-designed esophageal covered stents were placed successfully at the first attempt in 24 cases (88.9%). The total operative time was 5-15 min. The stents were removed 7 days to 3 months after leakage healing. Follow-up showed no leakage recurrence; three patients had anastomosis scar strictures. Fifteen patients died (median survival 13.4 months) and nine survived. CONCLUSION Placement of the novel esophageal covered stent is a minimally invasive, efficacious treatment option for the patients with cervical anastomotic leakage after esophagectomy.
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Affiliation(s)
- Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yan Shi Zhao
- Division of Gastroenterology and Hepatology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, CA, 92354, USA
| | - Yi Fang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Gaofeng Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jia Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Blakely AM, Ajmal S, Sargent RE, Ng TT, Miner TJ. Critical analysis of feeding jejunostomy following resection of upper gastrointestinal malignancies. World J Gastrointest Surg 2017; 9:53-60. [PMID: 28289510 PMCID: PMC5329704 DOI: 10.4240/wjgs.v9.i2.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/09/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess nutritional recovery, particularly regarding feeding jejunostomy tube (FJT) utilization, following upper gastrointestinal resection for malignancy.
METHODS A retrospective review was performed of a prospectively-maintained database of adult patients who underwent esophagectomy or gastrectomy (subtotal or total) for cancer with curative intent, from January 2001 to June 2014. Patient demographics, the approach to esophagectomy, the extent of gastrectomy, FJT placement and utilization at discharge, administration of parenteral nutrition (PN), and complications were evaluated. All patients were followed for at least ninety days or until death.
RESULTS The 287 patients underwent upper GI resection, comprised of 182 esophagectomy (n = 107 transhiatal, 58.7%; n = 56 Ivor-Lewis, 30.7%) and 105 gastrectomy [n = 63 subtotal (SG), 60.0%; n = 42 total (TG), 40.0%]. 181 of 182 esophagectomy patients underwent FJT, compared with 47 of 105 gastrectomy patients (99.5% vs 44.8%, P < 0.0001), of whom most had undergone TG (n = 39, 92.9% vs n = 8 SG, 12.9%, P < 0.0001). Median length of stay was similar between esophagectomy and gastrectomy groups (14.7 d vs 17.1 d, P = 0.076). Upon discharge, 87 esophagectomy patients (48.1%) were taking enteral feeds, with 53 (29.3%) fully and 34 (18.8%) partially dependent. Meanwhile, 20 of 39 TG patients (51.3%) were either fully (n = 3, 7.7%) or partially (n = 17, 43.6%) dependent on tube feeds, compared with 5 of 8 SG patients (10.6%), all of whom were partially dependent. Gastrectomy patients were significantly less likely to be fully dependent on tube feeds at discharge compared to esophagectomy patients (6.4% vs 29.3%, P = 0.0006). PN was administered despite FJT placement more often following gastrectomy than esophagectomy (n = 11, 23.4% vs n = 7, 3.9%, P = 0.0001). FJT-specific complications requiring reoperation within 30 d of resection occurred more commonly in the gastrectomy group (n = 6), all after TG, compared to 1 esophagectomy patient (12.8% vs 0.6%, P = 0.0003). Six of 7 patients (85.7%) who experienced tube-related complications required PN.
CONCLUSION Nutritional recovery following esophagectomy and gastrectomy is distinct. Operations are associated with unique complication profiles. Nutritional supplementation alternative to jejunostomy should be considered in particular scenarios.
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Ryan CE, Paniccia A, Meguid RA, McCarter MD. Transthoracic Anastomotic Leak After Esophagectomy: Current Trends. Ann Surg Oncol 2016; 24:281-290. [PMID: 27406098 DOI: 10.1245/s10434-016-5417-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Leaks from intrathoracic esophagogastric anastomosis are thought to be associated with higher rates of morbidity and mortality than leaks from cervical anastomosis. We challenge this assumption and hypothesize that there is no significant difference in mortality based on the location of the esophagogastric anastomosis. METHODS A systematic literature search was conducted using PubMed and Embase databases on all studies published from January 2000 to June 2015, comparing transthoracic (TTE) and transhiatal (THE) esophagectomies. Studies using jejunal or colonic interposition were excluded. Outcomes analyzed were leak rate, leak-associated mortality, overall 30-day mortality, and overall morbidity. Meta-analyses were performed using Mantel-Haenszel statistical analyses on studies reporting leak rates of both approaches. Nominal data are presented as frequency and interquartile range (IQR); measures of the association between treatments and outcomes are presented as odds ratio (OR) with 95 % confidence interval. RESULTS Twenty-one studies (3 randomized controlled trials) were analyzed comprising of 7167 patients (54 % TTE). TTE approach yields a lower anastomotic leak rate (9.8 %; IQR 6.0-12.2 %) than THE (12 %; IQR 11.6-22.1 %; OR 0.56 [0.34-0.92]), without any significant difference in leak associated mortality (7.1 % TTE vs. 4.6 % THE: OR 1.83 [0.39-8.52]). There was no difference in overall 30-day mortality (3.9 % TTE vs. 4.3 % THE; OR 0.86 [0.66-1.13]) and morbidity (59.0 % TTE vs. 66.6 % THE; OR 0.76 [0.37-1.59]). DISCUSSION Based on meta-analysis, TTE is associated with a lower leak rate and does not result in higher morbidity or mortality than THE. The previously assumed higher rate of transthoracic anastomotic leak-associated mortality is overstated, thus supporting surgeon discretion and other factors to influence the choice of thoracic versus cervical anastomosis.
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Affiliation(s)
- Carrie E Ryan
- University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Alessandro Paniccia
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Martin D McCarter
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Aurora, CO, USA
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Chen Z, Zhang N, Chen X. Application of Oesophagogastric Cervical Mechanical Anastomosis in Oesophagectomy for Cancer. Indian J Surg 2016; 77:941-4. [PMID: 27011487 DOI: 10.1007/s12262-014-1069-7] [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: 10/16/2013] [Accepted: 04/01/2014] [Indexed: 11/24/2022] Open
Abstract
We aimed to explore the safety and the feasibility of the application of digestive tract-specific circular anastomats in oesophagogastric cervical anastomosis after oesophagectomy for cancer. We retrospectively analysed the clinical data of 241 patients undergoing oesophagogastric cervical anastomosis using disposable circular staplings after oesophagectomy in the People's Hospital of Henan Province, from August 2009 to July 2012. A total of 240 patients were anastomosed successfully. One patient had a partially torn oesophagus and underwent repair because the wrong stapler size was used. No operative death occurred. Seven patients (2.9 %) had postoperative cervical anastomotic leakage but recovered after short-term conservative treatment, and three patients had obvious gastro-oesophageal reflux after eating. No intrathoracic anastomotic leakage or other anastomotic instrument-related complications occurred. During a median follow-up period of 13.8 months, no anastomotic stricture was found in each patient. The application of oesophagogastric cervical anastomosis using circular anastomat after oesophagectomy for cancer was safe and feasible.
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Affiliation(s)
- Zhong Chen
- Thoracic Oncology Center, The People's Hospital of Henan Province, Zhengzhou, 450003 China
| | - Ning Zhang
- Thoracic Oncology Center, The People's Hospital of Henan Province, Zhengzhou, 450003 China
| | - Xiao Chen
- Thoracic Oncology Center, The People's Hospital of Henan Province, Zhengzhou, 450003 China
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11
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Irino T, Tsai JA, Ericson J, Nilsson M, Lundell L, Rouvelas I. Thoracoscopic side-to-side esophagogastrostomy by use of linear stapler-a simplified technique facilitating a minimally invasive Ivor-Lewis operation. Langenbecks Arch Surg 2016; 401:315-22. [PMID: 26960591 DOI: 10.1007/s00423-016-1396-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/01/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Minimally invasive esophagectomy (MIE) has been met with increased interest for the surgical treatment of esophageal cancer. One critical obstacle for the implementation of MIE has been the intrathoracic anastomosis. In this study, we describe a technique of thoracoscopic intrathoracic anastomosis using a linear stapler in prone position and present the short-term outcomes of this procedure. METHODS This prospective pilot study included 46 consecutive patients with a cancer either of the gastroesophageal junction (GEJ) or the distal esophagus who underwent either total MIE or thoracoscopic-assisted esophagectomy followed by intrathoracic stapled side-to-side anastomosis. The short-term outcomes including postoperative complications were recorded and analyzed. RESULTS This pilot study included 41 males (89 %) and 5 females (11 %) with a mean age of 65.7 years. The majority had adenocarcinoma (93 %). Before surgery, 4 patients (8.7 %) had an incomplete endoscopic submucosal resection, 5 patients (11 %) received chemotherapy alone, and 33 patients (71 %) had chemoradiotherapy. Mean operation time was 408 minutes. Postoperative complications classified as Clavien-Dindo Grade IIIa or more severe occurred in 7 patients (15 %), of whom 4 patients (8.7 %) developed anastomotic leakages without any need for intensive care. Another 2 patients (4.3 %) required intensive care due to aspiration pneumonia and acute renal failure. No in-hospital mortality was registered. Only one patient (2.2 %) with anastomotic leakage developed postoperative anastomotic stenosis requiring balloon dilatation. CONCLUSIONS The intrathoracic stapled side-to-side anastomosis technique seems to be feasible, safe, and easy to perform, associated with a limited postsurgical complication rate and a good functional outcome.
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Affiliation(s)
- Tomoyuki Irino
- Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
| | - Jon A Tsai
- Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.,Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden
| | - Jessica Ericson
- Department of Clinical Nutrition and Dietetics, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
| | - Magnus Nilsson
- Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.,Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden
| | - Lars Lundell
- Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.,Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden
| | - Ioannis Rouvelas
- Center for Digestive Diseases, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden. .,Division of Surgery, CLINTEC, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden.
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12
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Nakata K, Nagai E, Ohuchida K, Nakamura K, Tanaka M. Outcomes of cervical end-to-side triangulating esophagogastric anastomosis with minimally invasive esophagectomy. World J Surg 2015; 39:1099-104. [PMID: 25582767 DOI: 10.1007/s00268-014-2925-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Esophagogastric anastomosis after esophagectomy has been performed with a variety of techniques during the past decade. However, anastomotic leakage and stricture are still important clinical problems after esophagogastric anastomosis, causing burdensome symptoms and poor quality of life. Herein, we describe a novel cervical end-to-side triangulating esophagogastric anastomoasis using linear stapler. METHODS A total of 90 patients (85 % male; mean age 63 years) with thoracic esophageal cancer who underwent cervical end-to-side esophagogastric triangular anastomosis using a linear stapler after minimally invasive esophagectomy between November 2006 and April 2013 were retrospectively reviewed. RESULTS The median operation time was 602 min (range 424-936 min). The volume of blood loss during the entire operative procedure was 127 ml (range 0-700 ml). There were no cases of anastomotic leakage in this study, although four patients (4.4 %) developed dysphagia associated with benign anastomotic stricture formation. All patients with a benign anastomotic stricture underwent balloon dilation, which resulted in improvement in their symptoms. CONCLUSIONS Considering the absence of anastomotic leakage and low rate of anastomotic stricture formation in this study, our modified triangular esophagogastric anastomosis technique appears promising and may contribute to reduced morbidity and mortality rates following esophagectomy.
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Affiliation(s)
- Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan,
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13
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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: 37] [Impact Index Per Article: 4.1] [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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Shah DR, Martinez SR, Canter RJ, Yang AD, Bold RJ, Khatri VP. Comparative morbidity and mortality from cervical or thoracic esophageal anastomoses. J Surg Oncol 2013; 108:472-6. [DOI: 10.1002/jso.23423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/06/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Dhruvil R. Shah
- Department of Surgery; Division of Surgical Oncology; Davis School of Medicine; University of California; Sacramento California
| | - Steve R. Martinez
- Department of Surgery; Division of Surgical Oncology; Davis School of Medicine; University of California; Sacramento California
| | - Robert J. Canter
- Department of Surgery; Division of Surgical Oncology; Davis School of Medicine; University of California; Sacramento California
| | - Anthony D. Yang
- Department of Surgery; Division of Surgical Oncology; Davis School of Medicine; University of California; Sacramento California
| | - Richard J. Bold
- Department of Surgery; Division of Surgical Oncology; Davis School of Medicine; University of California; Sacramento California
| | - Vijay P. Khatri
- Department of Surgery; Division of Surgical Oncology; Davis School of Medicine; University of California; Sacramento California
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15
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Gockel I, Paschold M, Lang H, Heid F. Minimalinvasive abdominothorakale Ösophagusresektion mit transoraler Ösophagogastrostomie. Anaesthesist 2013; 62:836-44. [DOI: 10.1007/s00101-013-2223-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Terra Júnior JA, Terra GA, Silva AAD, Crema E. Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy. Acta Cir Bras 2013; 27:650-8. [PMID: 22936092 DOI: 10.1590/s0102-86502012000900011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/19/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy, were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.
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Klink CD, Binnebösel M, Otto J, Boehm G, von Trotha KT, Hilgers RD, Conze J, Neumann UP, Jansen M. Intrathoracic versus cervical anastomosis after resection of esophageal cancer: a matched pair analysis of 72 patients in a single center study. World J Surg Oncol 2012; 10:159. [PMID: 22866813 PMCID: PMC3489570 DOI: 10.1186/1477-7819-10-159] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/15/2012] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. Methods 72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates. Results Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11%) vs. 11 of 36 patients (31%); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10–110) vs. 26 days (range 12 – 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046). The overall In-hospital mortality rate was 6% (4 of 72 patients) without any differences between the study groups. Conclusions The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.
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Affiliation(s)
- Christian D Klink
- Department of General, Visceral and Transplantation Surgery, Aachen, Germany.
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Cafarotti S, Cesario A, Porziella V, Granone P. eComment. Oesophagectomy: Could the anastomotic location be an independent prognostic factor? Interact Cardiovasc Thorac Surg 2012; 14:826-7. [PMID: 22589349 DOI: 10.1093/icvts/ivs171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefano Cafarotti
- Department of General Thoracic surgery, Catholic University of Rome, Rome, Italy
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