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.

scholarly journals Anastomotic leakage after esophagectomy possibly caused by compression of the gastric conduit behind the sternoclavicular joint: a report of three cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasunori Kurahashi ◽  
Yudai Hojo ◽  
Tatsuro Nakamura ◽  
Tsutomu Kumamoto ◽  
Yoshinori Ishida ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Gastric Wall ◽  
Sternoclavicular Joint ◽  
Gastric Conduit ◽  
Thoracic Inlet ◽  
Indocyanine Green Fluorescence ◽  
Subtotal Esophagectomy ◽  
First Case

Abstract Background The narrowness of the thoracic inlet is often a problem in retrosternal reconstruction after esophagectomy. We report here three cases in which compression of the gastric conduit behind the sternoclavicular joint possibly caused anastomotic leakage. Case presentations The first case was a 71-year-old man who underwent subtotal esophagectomy for upper esophageal cancer followed by retrosternal reconstruction. On postoperative day 2, he developed septic shock and underwent reoperation because of a necrotic gastric conduit. The tip of the conduit above the manubrium was necrotic due to strangulation as a result of compression by the sternoclavicular joint. The second and third cases were a 50-year-old woman and a 71-year-old man who underwent subtotal esophagectomy for middle and lower esophageal cancer, respectively, followed by retrosternal reconstruction. Despite indocyanine green fluorescence imaging indicating adequate blood flow in both cases, the tip of the conduit appeared pale and congested because of compression by the sternoclavicular joint after anastomosis. Postoperatively, these two patients developed anastomotic leakage that was confirmed endoscopically on the ventral side of the gastric wall that had been pale intraoperatively. Conclusions When performing reconstruction using the retrosternal route after esophagectomy, it is important to ensure that compression by the sternoclavicular joint does not have an adverse impact on blood flow at the tip of the gastric conduit.

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.

649 EFFECTS OF THE PREPARATION METHOD ON THE ICG FLUORESCENCE BLOOD FLOW IN THE GASTRIC CONDUIT AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kazuo Koyanagi ◽  
Soji Ozawa ◽  
Yamato Ninomiya ◽  
Kentaro Yatabe ◽  
Tadashi Higuchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Fluorescence Imaging ◽  
Conventional Method ◽  
Current Method ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Gastric Artery ◽  
Conduit Wall ◽  
Lesser Curvature

Abstract   In this study, we investigated how the blood flow of gastric conduit changed due to the difference in the lesser curvature cut line using ICG fluorescence imaging in patients with esophageal cancer. Methods A total of 193 cases of esophageal cancer surgery with gastric conduit reconstruction were included. (Conventional method) The lesser curvature cut line of the stomach was started from a distance of 5 cm from the pylorus (141 cases). (Current method) Gastric lesser curvature dissection was started from the last branch of the left gastric artery (52 cases). Blood flow of the gastric conduit was measured by the ICG fluorescence imaging, and the correlation between the changes in the gastric conduit and both blood flow and anastomotic failure was examined. Results Median length of the lesser curvature cut line was 10 cm from the pylorus in the current method, which was significantly longer than that in the conventional method (P < 0.001). Congestion at the tip of the gastric conduit were more observed in the conventional method (P = 0.02). The ICG fluorescent blood flow speed in the gastric conduit wall was 2.54 cm/s by the conventional method and 2.82 cm/s by the current method (P = 0.03). There were 23 cases (16.3%) of anastomotic leakage in the conventional method and 4 cases (7.7%) in the current method (P = 0.09). Conclusion By preserving the right gastric artery and vein, improvement of venous return is expected, and it is suggested that blood flow in the gastric conduit wall can be well maintained.

Utility of Thermography of Reconstructed Gastric Conduit for Predicting Postoperative Anastomotic Leakage After Esophagectomy for Esophageal Cancer

2021 ◽  
Vol 41 (1) ◽  
pp. 453-458
Author(s):  
MAKOTO SOHDA ◽  
TATSUYA MIYAZAKI ◽  
TAKAYOSHI WATANABE ◽  
NOBUHIRO NAKAZAWA ◽  
YASUNARI UBUKATA ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Gastric Conduit

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.

scholarly journals Surgeon at Work: Hand-Assisted Laparoscopic Construction of Gastric Conduit for Thoracic Esophageal Cancer

2001 ◽  
Vol 7 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Tatsuya Aoki ◽  
Akihiko Tsuchida ◽  
Yoshiaki Osaka ◽  
Yu Takagi ◽  
Motoo Shinohara ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Procedure ◽  
Operating Time ◽  
Gastric Conduit ◽  
The Body ◽  
Greater Omentum ◽  
Esophageal Hiatus ◽  
Endoscopic Surgical Procedure ◽  
Thoracic Esophageal Cancer ◽  
Time Required

A method for hand-assisted laparoscopic construction of gastric conduit for thoracic esophageal cancer was developed. Since this endoscopic surgical procedure is less invasive than open surgery, it contributes to improvement of post-operative respiratory functions and reduces respiratory complications. What distinguishes our surgical procedure is that unlike methods described in previous reports, it begins with treatment of the left gastroepiploic vessels at the height of the inferior edge of the spleen, followed by dissection from the esophageal hiatus to the lesser curvature and then dissection and excision of left gastric arteries and veins. Finally, the exposed esophagus and stomach are drawn outside the body and the right gastroepiploic blood vessels are preserved, followed by dissection of the greater omentum. This approach to gastric conduit construction was undertaken in 6 patients and the mean operating time was 123 minutes. Although in the first 3 of these patients the operating time was 150 minutes or more, the time required shortened to around 90 minutes for each of the last 3 cases, as the procedure was mastered. In each case, the volume of intraoperative hemorrhage did not exceed 50 ml.

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 Risk-Assessment of Esophageal Surgery: Diagnosis and Treatment of Celiac Trunk Stenosis

2018 ◽  
Vol 07 (01) ◽  
pp. e21-e23 ◽  
Author(s):  
Rosa Lammerts ◽  
Marc van Det ◽  
Rob Geelkerken ◽  
Ewout Kouwenhoven
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Celiac Trunk ◽  
Esophageal Surgery ◽  
Gastric Conduit ◽  
Mesenteric Arteries ◽  
Life Threatening ◽  
Resectable Esophageal ◽  
Resectable Esophageal Cancer ◽  
Artery Disease

AbstractAnastomotic leakage of the gastric conduit following surgical treatment of esophageal cancer is a life-threatening complication. An important risk factor associated with anastomotic leakage is calcification of the supplying arteries of the gastric conduit. The patency of calcified splanchnic arteries cannot be assessed on routine computed tomography (CT) scans for esophageal cancer and, as such, in selected patients with known or assumed mesenteric artery disease, additional CT angiography of the abdominal arteries with 1 mm slices is strongly encouraged. If the mesenteric perfusion is compromised in patients with resectable esophageal cancer, angioplasty procedures with stenting of the mesenteric arteries could be performed to prevent possible ischemia of the gastric conduit.

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