591 Treating Complete Occlusion of the Esophagogastric Anastomosis After Transhiatal Esophagectomy - A Laparoscopic-Assisted Double-Endoscopy Technique

Abstract Post esophagectomy anastomotic leakage and stricture are crucial factors in determining morbidity and mortality. Good vascularity of the gastric conduit is essential to avoid this complications. This prospective study assesses the utility of intraoperative indocyanine green (ICG) fluorescence imaging to determine gastric conduit vascularity in patients undergoing esophagectomy. Methods Thirteen consecutive patients who were undergoing esophagectomy for carcinoma middle, lower third esophagus or gastro-esophageal junction from August 2019 to September 2019, were included. Three patients underwent laparoscopic-assisted transhiatal esophagectomy, ten thoraco-laparoscopic assisted esophagectomy. Reconstruction was done by gastric pull up via posterior mediastinal route. Vascularity of gastric conduit was assessed by the near-infrared camera using ICG. Results On visual assessment of perfusion at the tip of gastric conduit, it was dusky in 11 patients, pink in two. Fuorescence imaging showed inadequate perfusion at the tip of conduit in 12 patients, needing revision. In one patient visual inspection showed adequate perfusion, but ICG disclosed poor vascularity requiring revision of the conduit’s tip. Resection of the devitalized portion of the proximal esophageal stump was needed in 5 patients both by visual and ICG assessment. The median time to appearance of blush from the time of injection of dye was 15 seconds (10 to 23 seconds). Conclusion Visual inspection of the gastric conduit vascularity can underestimate perfusion and hence can compromise resection of the devitalized part. ICG fluorescence imaging is more objective and promising means to ascertain the vascularity of gastric conduit during an esophagectomy. It could complement the visual inspection to decide the site of anastomosis.

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Transthoracic anastomotic leak after esophagectomy: Still a catastrophe?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.126 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 126-126

Author(s):

Martin McCarter ◽

Carrie Ryan ◽

Robert Meguid ◽

Alessandro Paniccia

Keyword(s):

Anastomotic Leak ◽

Transhiatal Esophagectomy ◽

Leak Rate ◽

Esophagogastric Anastomosis ◽

Nominal Data ◽

Cervical Anastomosis ◽

Randomized Controlled ◽

Significant Difference ◽

Cervical Esophagogastric Anastomosis ◽

Meta Analyses

126 Background: 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 position of the esophagogastric anastomosis. Methods: A systematic literature search was conducted using PubMed and Embase databases on all studies published between January 2000 and June 2015 comparing transthoracic (TTE) and transhiatal (THE) esophagectomies. Studies that used alternate reconstruction approaches 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 that reported on 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 (CI). Results: Twenty-one studies (including 3 randomized controlled trials) were included comprising of 7167 patients (54% TTE). THE approach yields a higher anastomotic leak rate (12%; IQR: 11.6% - 22.1%) than TTE (9.8%; IQR: 6.0% - 12.2%) (OR: 1.83 [0.34-06.92]), without any 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]). Conclusions: Transthoracic esophagectomy is associated with a lower leak rate and does not result in higher morbidity or mortality than transhiatal esophagectomy. The previously assumed higher rate of transthoracic leak-associated mortality is overstated, thus allowing surgeon discretion and other factors to influence the choice of intrathoracic versus cervical esophagogastric anastomosis.

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Outcomes of laparoscopic-assisted transhiatal esophagectomy for adenocarcinoma of the esophagus and esophago-gastric junction

Diseases of the Esophagus ◽

10.1111/j.1442-2050.2010.01165.x ◽

2011 ◽

Vol 24 (6) ◽

pp. 430-436 ◽

Cited By ~ 24

Author(s):

M. I. Montenovo ◽

K. Chambers ◽

C. A. Pellegrini ◽

B. K. Oelschlager

Keyword(s):

Transhiatal Esophagectomy ◽

Adenocarcinoma Of The Esophagus ◽

Laparoscopic Assisted

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Laparoscopic transhiatal esophagectomy improves hospital outcomes and reduces cost: a single-institution analysis of laparoscopic-assisted and open techniques

Surgical Endoscopy ◽

10.1007/s00464-015-4519-9 ◽

2015 ◽

Vol 30 (6) ◽

pp. 2535-2542 ◽

Cited By ~ 6

Author(s):

Brett L. Ecker ◽

Goda E. Savulionyte ◽

Jashodeep Datta ◽

Kristoffel R. Dumon ◽

John Kucharczuk ◽

...

Keyword(s):

Transhiatal Esophagectomy ◽

Single Institution ◽

Hospital Outcomes ◽

Laparoscopic Assisted

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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

10.21203/rs.3.rs-17780/v3 ◽

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.

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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

BMC Gastroenterology ◽

10.1186/s12876-020-01393-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Seyed Ziaeddin Rasihashemi ◽

Ali Ramouz ◽

Samad Beheshtirouy ◽

Hassan Amini

Keyword(s):

Esophageal Cancer ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Transhiatal Esophagectomy ◽

Esophagogastric Anastomosis ◽

Thoracic Esophageal Cancer ◽

Cervical Esophagogastric Anastomosis

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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

10.21203/rs.3.rs-17780/v2 ◽

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.

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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

10.21203/rs.3.rs-17780/v4 ◽

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.

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