Impact of Anastomotic Leakage on Survival for Patients with Thoracic Esophageal Cancer Performed with Esophagectomy Followed by Right Colon Interposition

2021 ◽  
Author(s):  
Junya Kitadani ◽  
Toshiyasu Ojima ◽  
Masaki Nakamura ◽  
Keiji Hayata ◽  
Masahiro Katsuda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Colon Interposition ◽  
Right Colon ◽  
Thoracic Esophageal Cancer

scholarly journals Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

2020 ◽  
Author(s):  
Seyed Ziaeddin Rasihashemi ◽  
Ali Ramouz ◽  
Samad Beheshtirouy ◽  
Hassan Amini
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Anastomotic Stricture ◽  
Anastomosis Group ◽  
Transhiatal Esophagectomy ◽  
Stapled Anastomosis ◽  
Esophagogastric Anastomosis ◽  
Thoracic Esophageal Cancer ◽  
Cervical Esophagogastric Anastomosis

Abstract Background: Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients.Methods: This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in two weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation.Results: Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46±84.33 min and 250.55±43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02).Conclusion: Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

scholarly journals A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Noriyuki Hirahara ◽  
Takeshi Matsubara ◽  
Shunsuke Kaji ◽  
Yuki Uchida ◽  
Tetsu Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Nasogastric Tube ◽  
Simple Technique ◽  
Gastric Conduit ◽  
Intraluminal Pressure ◽  
Linear Stapler ◽  
Thoracic Esophageal Cancer ◽  
Nylon Thread ◽  
Lesser Curvature

Abstract Background Risk factors for anastomotic leakage include local factors such as excessive tension across anastomosis and increased intraluminal pressure on the gastric conduit; therefore, we consider the placement of a nasogastric tube to be essential in reducing anastomotic leakage. In this study, we devised a safe and simple technique to place an NGT during an end-to-side, automatic circular-stapled esophagogastrostomy. Methods First, a 4-0 nylon thread is fixed in the narrow groove between the plastic and metal parts of the tip of the anvil head. After dissecting the esophagus, the tip of the NGT is guided out of the lumen of the cervical esophageal stump. The connecting nylon thread is applied to the anvil head with the tip of the NGT. The anvil head is inserted into the cervical esophageal stump, and a purse-string suture is performed on the esophageal stump to complete the anvil head placement. The main unit of the automated stapler is inserted through the tip of a reconstructed gastric conduit, and the stapler is subsequently fired and an end-to-side esophagogastrostomy is achieved. The main unit of the automated stapler is then pulled out from the gastric conduit, and the NGT comes out with the anvil head from the tip of the reconstructed gastric conduit. Subsequently, the nylon thread is cut. After creating an α-loop with the NGT outside of the lumen, the tip of the NGT is inserted into the gastric conduit along the lesser curvature toward the caudal side. Finally, the inlet of the automated stapler on the tip of the gastric conduit is closed with an automated linear stapler, and the esophagogastrostomy is completed. Results We utilized this technique in seven patients who underwent esophagectomy for esophageal cancer; smooth and safe placement of the NGT was accomplished in all cases. Conclusion Our technique of NGT placement is simple, safe, and feasible.

Surgical Outcome of Colon Interposition by the Posterior Mediastinal Route for Thoracic Esophageal Cancer

2007 ◽  
Vol 83 (4) ◽  
pp. 1273-1278 ◽  
Author(s):  
Satoru Motoyama ◽  
Michihiko Kitamura ◽  
Reijiro Saito ◽  
Kiyotomi Maruyama ◽  
Yusuke Sato ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Outcome ◽  
Colon Interposition ◽  
Thoracic Esophageal Cancer ◽  
Posterior Mediastinal ◽  
Posterior Mediastinal Route

scholarly journals Preoperative C-reactive Protein-to-albumin Ratio Predicts Anastomotic Leakage After Esophagectomy for Thoracic Esophageal Cancer: a Single-center Retrospective Cohort Study

2021 ◽  
Author(s):  
Atsushi Sugimoto ◽  
Takahiro Toyokawa ◽  
Yuichiro Miki ◽  
Mami Yoshii ◽  
Tatsuro Tamura ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Anastomotic Leakage ◽  
Squamous Cell ◽  
C Reactive Protein ◽  
Thoracic Esophageal Cancer ◽  
Albumin Ratio ◽  
Reactive Protein

Abstract Background: Postoperative anastomotic leakage (AL) is associated with not only prolonged hospital stay and increased medical costs, but also poor prognosis in esophageal cancer. Several studies have addressed the utility of various inflammation-based and/or nutritional markers as predictors for postoperative complications. However, none have been documented as specific predictors for AL in esophageal cancer. We aimed to identify predictors of AL after esophagectomy for thoracic esophageal cancer, focusing on preoperative inflammation-based and/or nutritional markers. Methods: We retrospectively analyzed 295 patients who underwent radical esophagectomy for thoracic esophageal squamous cell carcinoma between June 2007 and July 2020. As inflammation-based and/or nutritional markers, Onodera prognostic nutritional index, C-reactive protein (CRP)-to-albumin ratio (CAR) and modified Glasgow prognostic score were investigated. Optimal cut-off values of inflammation-based and/or nutritional markers for AL were determined by receiver operating characteristic curves. Predictors for AL were analyzed by logistic regression modeling. Results: AL was observed in 34 patients (11.5%). In univariate analyses, preoperative body mass index (≥22.1 kg/m2), serum albumin level (≤3.8 g/dL), serum CRP level (≥0.06 mg/dL), CAR (≥0.0139), operation time (>565 min) and blood loss (≥480 ml) were identified as predictors of AL. Multivariate analyses revealed higher preoperative CAR (≥0.0139) as an independent predictor of AL (p = 0.048, odds ratio = 3.02, 95% confidence interval 1.01–9.06).Conclusion: Preoperative CAR may provide a useful predictor of AL after esophagectomy for thoracic esophageal squamous cell carcinoma.

PS01.132: RISK FACTORS OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY WITH GASTRIC TUBE RECONSTRUCTION FOR THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 87-87
Author(s):  
Atsushi Sugimoto ◽  
Takahiro Toyokawa ◽  
Tatsuro Tamura ◽  
Katsunobu Sakurai ◽  
Naoshi Kubo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Circular Stapler ◽  
Thoracic Esophageal Cancer ◽  
Independent Risk Factors ◽  
Mechanical Anastomosis

Abstract Background Anastomotic leakage is a major complication after esophagectomy. Recent studies reported that anastomotic leakage is associated with poor prognosis. We aimed to identify the risk factors of anastomotic leakage after esophagectomy for thoracic esophageal cancer. Methods We analyzed retrospectively consecutive patients who underwent esophagectomy with reconstruction using gastric tube by cervical anastomosis for thoracic esophageal cancer between January 2009 and December 2017. In the reconstruction, end-to side mechanical anastomosis with circular stapler through the posterior mediastinal route was preferred until 2014, and end-to end hand-sewn anastomosis through the retrosternal route was preferred from 2015. As inflammation-based and/or nutritional markers, prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), Controlling Nutritional Status (CONUT) score, and neutrophil lymphocyte ratio (NLR) were investigated. Receiver operator characteristic curve analyses were performed to set the cut-off value of continuous variables. Risk factors predicting anastomotic leakage were analyzed using logistic regression model. Results A total of 170 patients (144 males and 26 females) were evaluated. Median age was 65 years (59 − 70). Anastomotic leakage was observed in 21 patients (12.3%). A mechanical anastomosis with circular stapler (P = 0.047) and longer operative time (≧560 minutes) (P = 0.015) were identified as risk factors of anastomotic leakage in univariate analysis. Multivariate analysis including variables with P < 0.1 on univariate analyses identified lower PNI (< 45) (P = 0.044, OR 2.78, 95% CI: 1.02 − 7.56) and mechanical anastomosis with a circular stapler (P = 0.036, OR 3.30, 95% CI: 1.07 − 10.09) as independent risk factors. Conclusion Our findings suggested that preoperative lower PNI and mechanical anastomosis were independent risk factors of anastomotic leakage after esophagectomy. Further studies aimed at preoperative nutritional intervention and anastomotic technique are warranted. Disclosure All authors have declared no conflicts of interest.

scholarly journals Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

2020 ◽  
Author(s):  
Seyed Ziaeddin Rasihashemi ◽  
Ali Ramouz ◽  
Samad Beheshtirouy ◽  
Hassan Amini
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Anastomotic Stricture ◽  
Anastomosis Group ◽  
Transhiatal Esophagectomy ◽  
Stapled Anastomosis ◽  
Esophagogastric Anastomosis ◽  
Thoracic Esophageal Cancer ◽  
Cervical Esophagogastric Anastomosis

Abstract Background: Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients. Methods: This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in two weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation. Results: Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46±84.33 min and 250.55±43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02). Conclusion: Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

scholarly journals Comparison of End-to-Side Hand-Sewn and Side-to-Side Stapled Cervical Esophagogastric Anastomosis in Patients with Lower Thoracic Esophageal Cancer Undergoing Transhiatal Esophagectomy: An Iranian Retrospective Cohort Study

2020 ◽  
Author(s):  
Seyed Ziaeddin Rasihashemi ◽  
Ali Ramouz ◽  
Samad Beheshtirouy ◽  
Hassan Amini
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Anastomotic Stricture ◽  
Anastomosis Group ◽  
Transhiatal Esophagectomy ◽  
Stapled Anastomosis ◽  
Esophagogastric Anastomosis ◽  
Thoracic Esophageal Cancer ◽  
Cervical Esophagogastric Anastomosis

Abstract Background: Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients.Methods: This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in two weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation.Results: Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46±84.33 min and 250.55±43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02).Conclusion: Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

scholarly journals Complications After Lymph Node Dissection Along Bilateral Recurrent Laryngeal Nerves Through Right Thoracic Approach in the Patients With Thoracic Esophageal Cancer

2021 ◽  
Author(s):  
Ligong Yuan ◽  
Feng Li ◽  
Yousheng Mao ◽  
Jie He ◽  
Shugeng Gao ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
New Technologies ◽  
Cell Cancer ◽  
Pulmonary Complications ◽  
Thoracic Esophageal Cancer ◽  
Thoracic Approach

Abstract Background: Extensive lymph nodes dissection can improve the accuracy of tumor staging and prognosis of the patients with thoracic esophageal cancer, palsy of recurrent laryngeal nerve (RLN) caused by the lymph node (LN) dissection along RLN chain also increase postoperative complications and may affect the prognosis. This study aimed to evaluate the associated postoperative complications after LN dissection along RLNs in the patients with thoracic esophageal squamous cell cancer (ESCC).Methods: 339 eligible patients with thoracic ESCC who underwent radical McKeown or Ivor-Lewis esophagectomy by open or VATS procedures through right thoracic approach with LN dissection along bilateral RLNs were included in this study. Univariate and multivariate logistic regression analysis were conducted to assess the correlation of RLN paralysis (RLNP) with other post-operative complications. Results: 39 of the 339 patients were diagnosed with RLNP (11.5%) postoperatively. The incidence of RLNP in three-field (3FL) LN dissection was significantly higher than that in the two-field (2FL) LN dissection ( 24.0% vs 8.0%, P＜0.001). Compared with the patients without RLNP, the patients with it had a significantly higher incidence of postoperative anastomotic leakage (P=0.029), pulmonary complications (P=0.001) and much longer hospital stay (P=0.001). Two patients died of respiratory failure within 30 days caused by RLNP and were treated by reintubation. Conclusion: RLNP after LN dissection along bilateral RLN in thoracic ESCC was associated with much higher morbidity such as pulmonary complications, anastomotic leakage, and much longer hospital stay. New technologies are required to reduce RLNP incidence and its associated complications.

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