scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

Author(s):  
Merel Lubbers ◽  
◽  
Frans van Workum ◽  
Gijs Berkelmans ◽  
Camiel Rosman ◽  
...  

Background: Anastomotic Leakage (AL) after Ivor Lewis Esophagectomy (ILE) is a severe complication that often needs immediate treatment. However, there is no consensus on the optimal treatment. The aim of this study was to describe the outcomes of the different treatment options in patients with either contained or uncontained AL after ILE. Methods: A retrospective analysis was performed on patients that developed AL after ILE in three high volume hospitals. Treatment was based on local preference. Endoscopic and surgical treatment were compared for patients with either contained (leakage confined to the mediastinum) or uncontained AL (leakage with intrapleural manifestations). Results: In total, 73 patients with an AL were included. A contained leak was observed in 39 patients. Twenty-five patients (64%) underwent an endoscopic approach that was successful in 19 patients (76%); fourteen patients (36%) underwent a surgical approach that was successful in 11 patients (79%). Significantly more patients were (re)admitted to the ICU in the surgical group; other outcomes were similar. An uncontained leak was observed in 34 patients. Endoscopic treatment was chosen in 14 patients (41%) and was successful in 10 patients (71%). A surgical approach was performed in 20 patients (59%) and was successful in 12 patients (60%). (Re) admission rate to the ICU was significantly higher in the surgical group, other outcomes were similar. Conclusions: This study demonstrates that there is high variability in the treatment of AL after esophagectomy. Surgical and endoscopic techniques are both successfully used for patients with either contained or uncontained leakages. However, more research is necessary before a treatment algorithm can be developed. Keywords: esophageal cancer; esophageal surgery; minimally invasive surgery; anastomotic leakage; endoscopic procedures.


2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Hannah Andrae ◽  
Thomas Musholt ◽  
Hauke Lang ◽  
Peter Grimminger

Abstract Background Esophagotracheal perforation is a very severe complication. However, an esophagotracheal perforation caused due to an esophageal stent after anastomotic leakage after ivor-lewis resection, is even more complex and associated with high mortality. Therefore we present a case how we managed a high esophagotracheal perforation and anastomotic leakage after ivor-lewis resection of esophageal cancer, prior treated with neoadjuvant radiochemotherapy. Methods Case report A 71-year old patient was transferred to our center due to an esophagotracheal perforation at the proximal stent—and at 18–20 cm from the front teeth row. The stent had been placed due to anastomotic leakage after ivor-lewis resection. The patient's history began with a squamous cell carcinoma of the esophagus, treated with neoadjuvant radiochemotherapy and followed by ivor-lewis esophagectomy. She developed an anastomotic leakage, which was treated with an esophageal stent. This stent perforated and caused a fistula between the esophagus and the trachea. Results After transfer to our center, we performed a tracheotomia with a tubus blocked, distal of the esophagotracheal fistula, to prevent a respiratory insufficiency. We removed the dislocated stent and induced an endosponge therapy. A prolonged healing process lead to a step-by-step decrease of the anastomotic leakage. Finally, the semicircular hole could be supplied by a fibrin sealant. We resected the fistula via cervical surgery and placed a pectoralis muscle flap between trachea and esophagus. The surgery was performed under steady neuromonitoring control. The postoperative course was uncomplicated. The patient could be extubated with spontaneous breathing. Eleven days after surgery, the patient could be discharged fully enteralised. The stomach interponate could be kept. Half a year later, our patient shows up in our regular consultation, reporting no dysphagia. Conclusion Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection. A stenting of the esophagus after finding an anastomotic leakage can be considered, but is associated with a risk of further complication. Disclosure All authors have declared no conflicts of interest.


2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Berend Van Der Wilk ◽  
Eliza R C Hagens ◽  
Ben M Eyck ◽  
Suzanne S Gisbertz ◽  
Richard Hillegersberg ◽  
...  

Abstract   To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.


2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Paolo Parise ◽  
Andrea Cossu ◽  
Leonardo Garutti ◽  
Francesco Puccetti ◽  
Ugo Elmore ◽  
...  

Abstract Background Indocyanine Green—Angiography (ICG-A) has been recently introduced for visceral perfusion evaluation. Aim of this study is to assess whether the intraoperative use of ICG-A can improve the evaluation of blood supply of the gastric conduit in Ivor-Lewis esophagectomy for cancer. Methods This is an interim analysis of a prospective interventional study ongoing at our Institution, on 160 Ivor-Lewis esophagectomy patients. After an intravenous bolus of ICG during the abdominal and thoracic stage, the gastric conduit perfusion was evaluated by means of a near infrared ICG-A and graded as ‘well’, ‘hypo-perfused’ or ‘ischemic’. If present, the ischemic or hypo-perfused area was resected. Demographic and clinical parameters and others, such as conduit perfusion speed, intra or post-operative hypotensive episodes have been analyzed. Results Currently 26 patients have been enrolled. An anastomotic leak of any grade was identified in 7 patients. Patients were divided in Group A (7 patients) who developed a leak and Group B (19 patients) who do not. No statistically significant differences were evidenced on demographic and preoperative clinical features, except for higher cigarette smoking history incidence in Group A. Those who developed a leak had an ‘hypo-perfused’ conduit at ICG-A in 71.4% and those who do not in only 15.8% (p 0.014). Median time from ICG injection to appearance of fluorescence at the basis of the gastric conduit was significantly longer in Group A than in Group B, 36 sec. (32–43.5) vs 28 sec. (20–39.8) (p 0.04) but median gastric conduit perfusion speed was similar. Patients in Group B had a higher median width of the conduit than Group A, 5cm (5.0–6.0) vs 4 (4.0–5.0) (p 0.032). Post-operative prolonged hypotensive episodes were seen more frequently in Group A than Group B (p 0.028). No differences were evidenced in terms of fluids infusions, blood loss, conduit length or intraoperative hypotensive episodes. Conclusion Preliminary results seem to show the usefulness of ICG-A in identifying patients at risk of leakage. Nevertheless no reduction of leakage incidence was induced by surgical strategy modification, probably because post-operative events may affect clinical course too. Definitive data have to be awaited. Disclosure All authors have declared no conflicts of interest.


Author(s):  
Motohiro Hirao ◽  
Takuya Hamakawa ◽  
Kazuhiro Nishikawa ◽  
Koji Takami ◽  
Takeshi Kato ◽  
...  

2019 ◽  
Vol 101 (1) ◽  
pp. e1-e4 ◽  
Author(s):  
D Schizas ◽  
A Michalinos ◽  
C Vergadis ◽  
D Oikonomou ◽  
E Baili ◽  
...  

Gastric tube conduit is the method of choice for restoring continuity of the digestive track after a partial or total esophagectomy. Redundant gastric conduit (i.e. an elongated, floppy conduit) is a rare cause of dysphagia in patients with long survival. Gastric tube volvulus is exceedingly rare with only three cases described in the literature. We present the diagnostic and therapeutic course of a 57-year-old man who presented to our department with gastric tube volvulus 32 months after an Ivor–Lewis esophagectomy. Diagnosis was made with computed tomography and volvulus was reduced endoscopically. To the best of our knowledge, this is only the fourth case of gastric tube volvulus described in the English literature. This rare situation might be a consequence of a redundant gastric tube. Endoscopic volvulus decompression was successful in our case.


2015 ◽  
Vol 30 (7) ◽  
pp. 3098-3098
Author(s):  
Jeremy Linson ◽  
Michael Latzko ◽  
Bestoun Ahmed ◽  
Ziad Awad

Author(s):  
Carlo Alberto De Pasqual ◽  
Jacopo Weindelmayer ◽  
Laura Gobbi ◽  
Luca Alberti ◽  
Alessandro Veltri ◽  
...  

2010 ◽  
Vol 34 (4) ◽  
pp. 738-743 ◽  
Author(s):  
Wolfgang Schröder ◽  
Arnulf H. Hölscher ◽  
Marc Bludau ◽  
Daniel Vallböhmer ◽  
Elfriede Bollschweiler ◽  
...  

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