Imaging of postoperative complications following Ivor-Lewis esophagectomy

Abstract Introduction: Postoperative complications after major upper gastrointestinal surgery can be devastating. Malnutrition has been found to be an important risk factor for postoperative complications. However, attempts at trying to detect malnourished patients preoperatively can be cumbersome and complex and are often not done. One simplified way of assessing nutritional status is the ANS system. The aim of this study was to show the relationship between ANS score and the postoperative outcome. Methodology: Medical record of all patients undergoing major EG and HB surgeries at Concord Hospital between 2010 and 2012 were retrospectively analysed. Results: 83 patients were operated and included (1) Whipples' procedure (20.5%), (2) total/subtotal gastrectomy (44.6%), (3) Ivor-Lewis esophagectomy (18%), and (4) distal pancreatectomy (14.5%). The mean ANS score was 1.58. Patients with higher ANS score (2 or more) were found to have significantly higher rates of wound infection (41% vs 12%, p<0.002), anastomotic leaks (13.7% vs 1.92%, p=0.034), unexpected return to operating theatre (31% vs 3.9%, p<0.001), slower return of bowel function as compared to patients with low ANS score (0 or 1). Conclusion: This study demonstrates the importance of screening for malnourished patients prior to their operation. Given its simplicity and effective predictive value, we recommend use of ANS system.

Download Full-text

P12 LONG-TERM QUALITY OF LIFE AFTER TOTAL GASTRECTOMY VERSUS IVOR LEWIS ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doz092.12 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

E Jezerskyte ◽

L M Saadeh ◽

E R C Hagens ◽

M A G Sprangers ◽

L Noteboom ◽

...

Keyword(s):

Quality Of Life ◽

Postoperative Complications ◽

Total Gastrectomy ◽

Nausea And Vomiting ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Significant Difference

Abstract Aim The aim of this study was to investigate the difference in long-term health-related quality of life in patients undergoing total gastrectomy versus Ivor Lewis esophagectomy in a tertiary referral center. Background & Methods Surgical treatment for gastroesophageal junction (GEJ) cancers is challenging. Both a total gastrectomy and an esophagectomy can be performed. Which of the two should be preferred is unknown given the scarce evidence regarding effects on surgical morbidity, pathology, long-term survival and health-related quality of life (HR-QoL). From 2014 to 2018, patients with a follow-up of > 1 year after either a total gastrectomy or an Ivor Lewis esophagectomy for GEJ or cardia carcinoma completed the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. Problems with eating, reflux and nausea and vomiting were chosen as the primary HR-QoL endpoints. The secondary endpoints were the remaining HR-QoL domains, postoperative complications and pathology results. Multivariable linear regression was applied taking confounders age, gender, ASA classification and neoadjuvant therapy into account. Results 30 patients after gastrectomy and 71 after Ivor Lewis esophagectomy with a mean age of 63 years were included. Median follow-up was two years (range 12-84 months). Patients after total gastrectomy reported significantly less choking when swallowing and coughing (β=-5.952, 95% CI -9.437 – -2.466; β=-13.084, 95% CI -18.525 – -7.643). Problems with eating, reflux and nausea and vomiting were not significantly different between the two groups. No significant difference was found in postoperative complications or Clavien-Dindo grade. Significantly more lymph nodes were resected in esophagectomy group (p=0.008). No difference in number of positive lymph nodes or R0 resection was found. Conclusion After a follow-up of > 1 year choking when swallowing and coughing were less common after total gastrectomy. No significant difference was found in problems with eating, reflux or nausea and vomiting nor in postoperative complications or radicality of surgery. Based on this study no general preference can be given to either of the procedures for GEJ cancer. Patients may be informed about the HR-QoL domains that are likely to be affected by the different surgical procedures, which in turn may support shared decision making when a choice between the two treatment options is possible.

Download Full-text

PS01.207: TRANSHIATAL AND INTERCOSTAL PLEURAL DRAINS AFTER HYBRID IVOR LEWIS ESOPHAGECTOMY: A COMPARATIVE ANALYSIS IN 100 CONSECUTIVE PATIENTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.207 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 108-108

Author(s):

Daniele Bernardi ◽

Emanuele Asti ◽

Andrea Sironi ◽

Gianluca Bonitta ◽

Luigi Bonavina

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Serum Albumin ◽

Total Dose ◽

Vacuum System ◽

Pleural Drainage ◽

Historical Cohort ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Significant Difference

Abstract Background In a previous proof of concept study, transhiatal pleural drain has been shown to be safe and effective after hybrid Ivor Lewis esophagectomy. Aim of the present study was to compare short-term outcomes of trans-hiatal and intercostal pleural drainage. We hypothesized that a trans-hiatal pleural drain introduced through the sub-xyphoid port site incision at laparoscopy could reduce postoperative pain and enhance patient recovery. Methods This was an observational retrospective cohort study. Two methods of pleural drainage were compared in patients undergoing hybrid Ivor Lewis esophagectomy. Patients treated with a transhiatal drain connected to a vacuum bag were compared to an historical cohort of patients treated with the conventional intercostal drain connected to under-water seal and suction. Postoperative morbidity, total and daily drainage output, serum albumin levels, and total dose of paracetamol and ketorolac administered on-demand were recorded. Postoperative complications were scored according to the Dindo-Clavien classification. Results Over a 2-year period, 50 patients with transhiatal drain and 50 with intercostal drains met the criteria for inclusion in the study. Demographic and clinico-pathological variables were similar in the two groups. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality nor statistical significant difference in the rate of grade ≥ 3 postoperative complications. The total volume of drain output and the serum albumin levels were similar in the two groups. The total dose of ketorolac was significantly reduced in patients with transhiatal drain (P < 0.001). The length of hospital stay was similar in the two groups. No complications related to the method of pleural drain occurred up to 3 months after hospital discharge. There was only one hospital readmission in the transhiatal group due to severe nutritional impairment. Conclusion Transhiatal pleural drainage connected to a portable vacuum system can safely replace the intercostal drain after hybrid Ivor-Lewis esophagectomy in selected patients. It has the potential to reduce postoperative pain and use of nonsteroidal antinflammatory drugs, and to enhance recovery from surgery. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Long-Term Quality of Life After Total Gastrectomy Versus Ivor Lewis Esophagectomy

World Journal of Surgery ◽

10.1007/s00268-019-05281-8 ◽

2019 ◽

Vol 44 (3) ◽

pp. 838-848 ◽

Cited By ~ 2

Author(s):

E. Jezerskyte ◽

L. M. Saadeh ◽

E. R. C. Hagens ◽

M. A. G. Sprangers ◽

L. Noteboom ◽

...

Keyword(s):

Quality Of Life ◽

Postoperative Complications ◽

Lymph Nodes ◽

Total Gastrectomy ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Eortc Qlq

Abstract Background There is scarce evidence on whether a total gastrectomy or an Ivor Lewis esophagectomy is preferred for gastroesophageal junction (GEJ) cancers regarding effects on morbidity, pathology, survival and health-related quality of life (HR-QoL). The aim of this study was to investigate the difference in long-term HR-QoL in patients undergoing total gastrectomy versus Ivor Lewis esophagectomy in a tertiary referral center. Methods Patients with a follow-up of >1 year after a total gastrectomy or an Ivor Lewis esophagectomy for GEJ/cardia carcinoma completed the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. ‘Problems with eating,’ ‘reflux,’ and ‘nausea and vomiting’ were the primary HR-QoL endpoints. The secondary endpoints were the remaining HR-QoL domains, postoperative complications and pathology results. Results Thirty patients after gastrectomy and 71 after esophagectomy were included. Mean age was 63 years. Median follow-up was 2 years (range 12–84 months). Patients after gastrectomy reported less ‘choking when swallowing’ and ‘coughing’ (β = − 5.952, 95% CI − 9.437 to − 2.466; β = − 13.084, 95% CI − 18.525 to − 7.643). More lymph nodes were resected in esophagectomy group (p = 0.008). No difference was found in number of positive lymph nodes, R0 resection or postoperative complications. Conclusions After a follow-up of >1 year ‘choking when swallowing’ and ‘coughing’ were less common after a total gastrectomy. No differences were found in postoperative complications or radicality of surgery. Based on this study, no general preference can be given to either of the procedures for GEJ cancer. These results support shared decision making when a choice between the two treatment options is possible.

Download Full-text

Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma

Digestive Surgery ◽

10.1159/000439442 ◽

2015 ◽

Vol 33 (1) ◽

pp. 58-65 ◽

Cited By ~ 2

Author(s):

Kirsten Lindner ◽

Daniel Palmes ◽

Amelie Grübener ◽

Norbert Senninger ◽

Jörg Haier ◽

...

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Risk Score ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Specific Risk

Download Full-text

Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08346-9 ◽

2021 ◽

Author(s):

Keouna Pather ◽

Adeline M. Deladisma ◽

Christina Guerrier ◽

Isaac R. Kriley ◽

Ziad T. Awad

Keyword(s):

Minimally Invasive ◽

Indocyanine Green ◽

Gastric Conduit ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Perfusion Assessment

Download Full-text

Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy

Journal of Surgical Oncology ◽

10.1002/jso.26550 ◽

2021 ◽

Author(s):

Brian Housman ◽

Dong‐Seok Lee ◽

Andrea Wolf ◽

Daniel Nicastri ◽

Andrew Kaufman ◽

...

Keyword(s):

Esophageal Stricture ◽

Gastric Leak ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy

Download Full-text

PS02.147: MANAGEMENT OF A SIMULTANEOUS HIGH ESOPHAGO-TRACHEAL FISTULA CAUSED BY ESOPHAGEAL STENT DUE TO ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY: A CASE REPORT

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.147 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 162-162

Author(s):

Hannah Andrae ◽

Thomas Musholt ◽

Hauke Lang ◽

Peter Grimminger

Keyword(s):

Case Report ◽

Anastomotic Leakage ◽

Healing Process ◽

Esophageal Stent ◽

Neoadjuvant Radiochemotherapy ◽

Carcinoma Of The Esophagus ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

First Choice ◽

Cervical Surgery

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.

Download Full-text