Complete mechanical cervical anastomosis using a narrow gastric tube after esophagectomy for cancer

Anastomotic leak and conduit necrosis are severe complications after esophagectomy. Fluorescent angiography with indocyanine green provides an opportunity to objectively evaluate conduit perfusion and, potentially, reduce the number of leaks. Material and methods. We analyzed short-term outcomes of 26 esophagectomies performed with laser fluorescent evaluation of conduit perfusion. All patients had esophagogastic anastomosis, 14 in the neck, 12 in the pleural cavity. Conduit perfusion was assessed 30 sec after intravenous bolus injection of 6 mg of indocya-nine green with SPY2000 laser technology. The results were compared with short-term outcomes of 35 esophagectomies performed without fluorescent assessment of gastric tube perfusion. Results. There were 6 leaks or conduit necrosis in control group while in the ICG group there were only 2 leaks on the neck: 1 in a patient with a massive intraoperative bleeding and shock, 1 in a patient with severely compromised blood supply of the gastric tube tip according to ICG imaging. No cases of conduit necrosis were found, which led to significantly lower number of severe (grade III-V Dindo-Clavien) complications, p=0,033. Conclusion Laser fluorescent angiography with indocyanine green is a useful tool which affords an objective evaluation of gastric tube perfusion and, potentially, reduces the number of severe postoperative complications after esophagectomy.

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Gastric tube cancer after esophagectomy for cancer: a systematic review

Diseases of the Esophagus ◽

10.1093/dote/doz049 ◽

2019 ◽

Vol 32 (8) ◽

Cited By ~ 1

Author(s):

Damiano Gentile ◽

Pietro Riva ◽

Anna Da Roit ◽

Silvia Basato ◽

Salvatore Marano ◽

...

Keyword(s):

Gastric Tube ◽

Case Reports ◽

Survival Rates ◽

Review Literature ◽

Cochrane Library ◽

Invasive Tumor ◽

Gastric Tube Cancer ◽

Publication Number ◽

Esophagectomy For Cancer

SUMMARY Gastric conduit used for reconstruction after esophagectomy for cancer has the potential to develop a metachronous neoplasm known as gastric tube cancer (GTC). The aim of this study was to review literature and evaluate outcomes and possible treatment strategies for GTC. A comprehensive systematic literature search was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library Central Register of Controlled Trials. No restriction was set for the type of publication, number, age, or sex of the patients. The search was limited to articles in English. Characteristics of esophageal cancer (EC) and its treatment and GTC and its treatment were analyzed. A total of 28 studies were analyzed, 12 retrospective analyses and 16 case reports, involving 229 patients with 250 GTCs in total. The majority of ECs (88.2%) were squamous cell carcinomas. In 120 patients (52.4%) a posterior mediastinal reconstructive route was used when esophagectomy was performed. The mean interval between esophagectomy and diagnosis of GTC was 55.8 months, with a median interval of 56.8 months (4–236 months). One hundred and twenty-four GTCs (49.6%) were located in the lower part of the gastric tube. One hundred and forty patients were endoscopically treated. Eighty-five patients underwent surgery. Thirty-six total gastrectomies with lymphadenectomy with colon or jejunal interposition were performed. Forty-three subtotal gastrectomies and 6 wedge resections were performed. The main reported postoperative complications were anastomotic leak, vocal cord palsy, and respiratory failure. Twenty-five patients were treated with palliative chemotherapy. Three-year survival rates were 69.3% for endoscopically treated patients, 58.8% for surgically resected patients, and 4% for patients who underwent palliative treatment. The feasibility of endoscopic resections in patients diagnosed with superficial GTC has been reported. Surgical treatment represented the preferred treatment method in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis. The development of GTC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer. Total gastrectomy plus lymphadenectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor, when endoscopy is contraindicated. Long-term yearly endoscopic follow-up is recommended.

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Risk factors for benign strictures after oesophagectomy and gastric tube reconstruction with cervical anastomosis

Gastroenterology ◽

10.1016/0016-5085(95)26241-5 ◽

1995 ◽

Vol 108 (4) ◽

pp. A482

Keyword(s):

Risk Factors ◽

Gastric Tube ◽

Cervical Anastomosis ◽

Gastric Tube Reconstruction

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309 ASSOCIATION BETWEEN CERVICAL ANASTOMOSIS METHODS AND ANASTOMOSIS STRICTURE AFTER ESOPHAGECTOMY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doab052.309 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Akihiro Suzuki

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Circular Stapler ◽

Pulmonary Complications ◽

Anastomotic Stenosis ◽

Linear Stapler ◽

Node Dissection ◽

Cervical Anastomosis ◽

Esophagectomy For Cancer

Abstract Esophagectomy with three-field lymph node dissection is the most important part of advanced esophageal cancer therapy, especially for squamous cell carcinoma (SCC) patients. After esophagectomy, cervical anastomosis with gastric tube is required. However, some patients suffer anastomotic stenosis and require endoscopic balloon dilations. In this study, we investigated the relationship between cervical anastomosis methods and anastomosis stricture after esophagectomy for cancer patients. Methods Patients with esophageal cancer undergoing radical esophagectomy with cervical anastomosis were identified from the prospectively maintained database at our institution. From 2013 to 2019, 28 patients received esophagectomy with cervical lymph node dissection in our institution. Association between anastomotic methods, linear stapler vs circular stapler, and other factors (patient characteristics, surgical complications including anastomotic stenosis, and length of postoperative stay) were analyzed. Results Their average age was 63.3 years. Males and SCC cases predominated. Thirteen patients (46%) received cervical anastomosis with the circular stapler (Group C), and 11 patients (39%) received treatment with the linear stapler (Group L). None of the following variables were significant different between the two methods: preoperative chemotherapy (53.8% in group C vs. 45.5% in group L; p = 0.58), length of hospital stay (25.8 vs. 20.7 days; p = 0.15), pulmonary complications (16.7% vs. 0.0%; p = 0.36), and anastomotic leakage (33.3% vs. 9.1%; p = 0.24). However, the rate of anastomotic stenosis without malignancies was significantly higher in group C patients (66.7% vs. 0%, p < 0.01). Conclusion Cervical anastomosis with the linear stapler may be safer and associated with a lower stenosis rate than with the circular stapler. In future, cervical anastomosis with linear stapler after mediastinoscopic esophagectomy would be better for not only esophageal SCC patients but also esophagogastric junction adenocarcinoma patients with pulmonary complications.

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