PS01.208: SURVEY ON THE MANAGEMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL RESECTION WITH GASTRIC TUBE RECONSTRUCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 108-109
Author(s):  
Eliza Hagens ◽  
Maarten Anderegg ◽  
Mark I Van Berge Henegouwen ◽  
Suzanne Gisbertz
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Locally Advanced ◽  
Treatment Guideline ◽  
Esophageal Resection ◽  
Esophageal Surgery ◽  
International Guideline ◽  
Radio Therapy ◽  
First Choice ◽  
Gastric Tube Reconstruction

Abstract Background For patients with locally advanced esophageal cancer, radical esophageal resection with gastric tube reconstruction preceded by chemo(radio)therapy offers the best chance for cure. Anastomotic leakage (AL) is one of the most severe complications following esophageal surgery, leading to significant morbidity, prolonged hospital stay, considerable costs, decreased quality of life and increased mortality. Management is complicated and not standardized. The objective is to gain insight into the different opinions on AL management among upper gastrointestinal surgeons and to verify the need for a diagnostic and treatment guideline. Methods Surgeons with particular interest in esophageal surgery, were invited to participate in an online questionnaire. The survey consisted of questions pertaining to the surgeons’ experience, operation characteristics, management routine and their opinion on international guidelines on the diagnosis and therapy of AL. Results Of the 331 invited physicians, 40% participated in the survey. 90.7% Use laboratory diagnostics and 62.8% imaging and/or endoscopy postoperatively on routine basis. In case of suspected AL, the first choice of diagnostic imaging modalities was mostly a CT scan (35.7%) or a dynamic swallow investigation (33.3%). In case of AL, indepently of the clincal manifestations (local symptoms only, medianstinal manifestations or In case of gastric conduit necrosis) the treatment strategies differed widely between surgeons (table 1). Over 70% of the responders agree that there is a need for a solid international guideline on AL management. Conclusion There is no general consensus in the management of AL. There is a need for an international guideline regarding the optimal management of AL. Disclosure All authors have declared no conflicts of interest.

FA05.03: EFFECT OF EPHEDRINE ON GASTRIC CONDUIT PERFUSION MEASURED BY LASER SPECKLE CONTRAST IMAGING (LSCO) AFTER ESOPHAGECTOMY: A PROSPECTIVE IN-VIVO COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 10-10
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Simon Strackee ◽  
Mark I Van Berge Henegouwen ◽  
Ton Van Leeuwen ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Gastric Conduit ◽  
Laser Speckle ◽  
Contrast Imaging ◽  
Laser Speckle Contrast Imaging ◽  
Speckle Contrast ◽  
Before And After ◽  
Gastric Tube Reconstruction

Abstract Background Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5–20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3–4%). Ephedrine is used widely in anesthesia to treat intra-operative hypotension and may improve perfusion by the increase of cardiac output (CO) and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by Laser Speckle Contrast Imaging (LSCI). Methods This prospective, observational, in-vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) towards decreased perfusion (fundus). Intra-patient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test. Results LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0·05) measured intra-patients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high. Conclusion This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux towards the fundus. Disclosure All authors have declared no conflicts of interest.

The sterno-tracheal distance is an important factor of anastomotic leakage of retrosternal gastric tube reconstruction after esophagectomy

Esophagus ◽  
2019 ◽  
Vol 17 (3) ◽  
pp. 264-269 ◽  
Author(s):  
Seiya Inoue ◽  
Takahiro Yoshida ◽  
Takeshi Nishino ◽  
Masakazu Goto ◽  
Yoshihito Furukita ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Gastric Tube Reconstruction

PS01.120: INVESTIGATION OF NUTRITIONAL INDICATORS COMPARING RECONSTRUCTION ROUTE AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 84-84
Author(s):  
Akihiro Tokuhisa ◽  
Shinsuke Kanekiyo ◽  
Shigeru Takeda ◽  
Hiroaki Nagano
Keyword(s):  
Survival Rate ◽  
Propensity Score ◽  
Surgical Complications ◽  
Gastric Tube ◽  
Nutritional Evaluation ◽  
Endoscopic Findings ◽  
First Choice ◽  
Posterior Mediastinal ◽  
Conut Score ◽  
Gastric Tube Reconstruction

Abstract Background The gastric tube reconstruction route after esophagectomy is generally adopted posterior mediastinal or retrosternal route. Currently it is selected for each hospital or case. Preoperative and postoperative nutritional assessment, surgical complications and rate of survival are retrospectively compared between Posterior mediastinal routec(Group P) and Retrosternal route (Group R). Methods From January 2006 to December 2015, 198 patients with gastric tube reconstruction after esophagectomy (112 patients in Group P and 86 patients in Group R) were included. Propensity score was calculated and adjusted by multiple logistic regression analysis because bias of background factors occurs. 1) Surgical complications and survival rate, 2) CONUT score as a nutritional evaluation index before, 6 months and 12 months after surgery, 3) Endoscopic findings at 12 months after surgery were examined. Results In Group R, there were more advanced cases with thoracotomy than Group P. As a result of matching these factors as covariates using Propensity score, 27 groups were extracted in each group. 1) Surgical complications and survival rate: There was no difference in the incidence of complications such as arrhythmia, suture failure, pulmonary complications between the two groups. There was no difference between PFS and OS in the two groups. 2) Nutritional Evaluation Indicator: The patients who recognized malnutrition (CONUT score 3 or more) before surgery (group P 9.3% vs. group R 7.4%, P = 0.715), 6 months after surgery (18.0% vs 15.4%, P = 1.000), 12 months after surgery (8.6% vs 22.9%, P = 0.049), group P had good nutritional status for 12 months postoperatively. 3) Endoscopic findings: Anastomotic stenosis (group P 22.5% vs. group R 10.2%, P = 0.052) tended to be few in group R. The occurrence of reflux esophagitis and food residue stagnation was not different between both groups. Conclusion Although short-term benefits such as ease of response to postoperative recurrence and postoperative complications are considered to be in retrosternal reconstruction, as the results of esophageal cancer treatment outcome improve, longer term of nutrition etc is taken from the viewpoint. The posterior mediastinal route is the first choice in our department. Disclosure All authors have declared no conflicts of interest.

PS01.190: FLEXIBLE GASTRIC TUBE: A NOBLE METHOD OF GASTRIC TUBE RECONSTRUCTION WITHOUT ANASTOMOTIC LEAKAGE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-104
Author(s):  
Yasuaki Nakajima ◽  
Kenro Kawada ◽  
Yutaka Tokairin ◽  
Akihiro Hoshino ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Clinical Outcomes ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Circular Stapler ◽  
Anastomotic Site ◽  
Subtotal Esophagectomy ◽  
The Status ◽  
Greater Curvature ◽  
Gastric Tube Reconstruction

Abstract Background Anastomotic leakage is one of the most frequent and severe morbidities after esophagectomy. For preventing anastomotic leakage, it is important to design a gastric tube with sufficient blood supply and to perform precise anastomosis at a well-conditioned site. We herein show our method of gastric tube reconstruction and evaluate the outcome. Methods Seven hundred and forty-six esophageal carcinoma patients who received subtotal esophagectomy with gastric tube reconstruction via the retrosternal route between 1994 and 2017 were enrolled in the present study. Although we previously used a greater curvature gastric tube with a 4 cm in diameter (narrow group), since 2000, a ‘flexible gastric tube,’ which was designed on an individual basis with the aim of preserving the vascular plexus in the center of the anterior and posterior stomach wall to the maximum possible extent in order to supply a sufficient amount of blood to the tip of the gastric tube was used (flexible group). Cervical esophagogastric end-to-side anastomosis using the circular stapler was performed during the whole period. The clinical outcomes were compared between the two groups. Results Anastomotic leakage was observed in 36 (4.8%) patients. While 24 of 155 (15.5%) patients showed anastomotic leakage in the narrow group, 12 of 591 (2.0%) patients showed anastomotic leakage in the flexible group and the clinical outcomes were significantly improved. Conclusion Our method of gastric tube reconstruction helped to improve the rate of anastomotic leakage after esophagectomy. At present, we are investigating the status of the blood flow using an ICG fluorescence method and by measuring the degree of oxygen saturation and hemoglobin using a new non-invasive monitoring tool during the operation. Postoperative assessments of the anastomotic site are performed using endoscopic examinations. We herein report the results of these assessments. Disclosure All authors have declared no conflicts of interest.

PS01.187: ASSESSMENT OF THE BLOOD SUPPLY USING THE INDOCYANINE GREEN FLUORESCENCE METHOD AND POSTOPERATIVE ENDOSCOPIC EVALUATION OF ANASTOMOSIS DURING ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-103
Author(s):  
Hiroyuki Kitagawa ◽  
Jun Iwabu ◽  
Tsutomu Namikawa ◽  
Kazuhiro Hanazaki
Keyword(s):  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Fluorescence Method ◽  
Control Group ◽  
Indocyanine Green Fluorescence ◽  
Conventional Procedure ◽  
Endoscopic Assessment ◽  
Gastric Tube Reconstruction

Abstract Background Postoperative anastomotic leakage is a severe complication after gastric tube reconstruction during esophagectomy. The aim of this study was to evaluate the usefulness of postoperative endoscopic assessment of anastomosis and its correlation with intraoperative indocyanine green (ICG) fluorescence assessment of the gastric tube. Methods We retrospectively reviewed 72 consecutive patients who underwent gastric tube reconstruction using the ICG fluorescence method during esophagectomy. Forty-six patients underwent the ICG line-marking method (LMM group; ICG before gastric tube creation). The other 26 underwent the conventional procedure and comprised the control group (ICG after gastric tube creation). Postoperative endoscopic assessment (PEA) of anastomosis was performed 7 days after surgery and results were classified as follows: grade 1 (normal or partial white coat), grade 2 (ulcer comprising less than half the circumference), and grade 3 (ulcer comprising more than half the circumference). Results Anastomotic leakage occurred in 7 of 72 patients (9.7%). The incidence of anastomotic leakage in the LMM group was tended to be lower than those in the control group (6.5% vs. 15.4%; P = 0.244). Of the 40 patients who underwent PEA, 3 (7.5%) had leakage. PEA grading was significantly associated with anastomotic leakage (P < 0.001). Better intraoperative ICG assessment was significantly associated with better endoscopic assessment grade (P = 0.041). Conclusion Intraoperative ICG assessment of the gastric tube was associated with PEA grading on anastomosis during esophagectomy. Disclosure All authors have declared no conflicts of interest.

62 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
S Inoue
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Independent Risk Factor ◽  
Cutoff Value ◽  
Subtotal Esophagectomy ◽  
Posterior Mediastinal ◽  
Route Reconstruction ◽  
Gastric Tube Reconstruction

Abstract Background Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009. Methods A total of 221 patients who underwent a subtotal esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared. Results The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in the RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in the RS route (p = 0.037). Conclusion The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD &lt;13 mm.

Calcification of Arteries Supplying the Gastric Tube: A New Risk Factor for Anastomotic Leakage after Esophageal Surgery

Radiology ◽  
2015 ◽  
Vol 274 (1) ◽  
pp. 124-132 ◽  
Author(s):  
Peter S. N. van Rossum ◽  
Leonie Haverkamp ◽  
Helena M. Verkooijen ◽  
Maarten S. van Leeuwen ◽  
Richard van Hillegersberg ◽  
...  
Keyword(s):  
Risk Factor ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Esophageal Surgery

670 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Seiya Inoue
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Independent Risk Factor ◽  
Cutoff Value ◽  
Posterior Mediastinal ◽  
Total Esophagectomy ◽  
Route Reconstruction ◽  
Gastric Tube Reconstruction

Abstract   Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009. Methods A total of 221 patients who underwent a sub total esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared. Results The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route reconstruction. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in RS route (p = 0.037). Conclusion The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD &lt;13 mm.

Sign in / Sign up

Export Citation Format

Share Document