P-OGC69 Incidence, presentation and long-term sequelae of hiatus hernia after oesophagectomy: a 10-year retrospective cohort study

Background Hiatus hernia after oesophagectomy is a rare but recognised event, with potentially life-threatening consequences when there is bowel compromise. This 10-year retrospective cohort study aimed to identify the incidence and evaluate the clinical presentation and long-term management of hiatus hernia after oesophagectomy. Methods We conducted a retrospective analysis of all oesophagectomies performed in a single tertiary centre over a 10-year study period between 2010 and 2019. Demographics, details of the initial procedure and long-term outcomes were analysed. Patients that underwent post-operative computed tomography (CT) imaging at ≥ 12 months post-operatively were included in analysis, with all CT scans independently reviewed by a radiologist. Results 212 patients were eligible for analysis. 25% (53/212) of patients developed a hiatus hernia post oesophagectomy. Demographic data were similar between patients who developed a hernia compared to those who did not. 75.5% (40/53) of post-operative hiatus hernias developed after transhiatal oesophagectomy (p < 0.001), and patients with post-operative hiatus hernia had a higher BMI (p = 0.009); this association was confirmed on multivariate analysis. Hiatus hernia was frequently under-reported, with only 58.5% (31/53) mentioned on the formal CT report. 81.1% of patients (43/53) were asymptomatic. Operative intervention was only performed in 1 patient presenting with small bowel obstruction as an emergency. Conclusions Hiatus hernia is a potentially clinically significant and under recognised long-term complication following oesophagectomy, with a significantly higher incidence following transhiatal oesophagectomy and in obese patients. With increasing long-term survival after surgical resection and its preponderance to be found incidentally on cross-sectional imaging, judicious screening for hiatus hernia is warranted to prevent fatal complications.

P-OGC78 One year experience of a newly established super green ERAS pathway for performing oesophago-gastric cancer resections during the Covid-19 pandemic

Background Surgical oncology services in the UK have been impacted by the COVID-19 pandemic. Various strategies have been employed in an attempt to continue cancer resectional surgery during the pandemic. This study examined our institution’s experience and outcomes with a newly established Super Green ERAS pathway for oesophago-gastric (OG) cancer resections during the pandemic. Methods A retrospective cohort study of consecutive patients who had a resection for OG cancer performed over a 12-month period beginning from the date of the first UK National Lockdown of 23 March 2020. Barring two intervals each lasting 3 weeks, urgent elective cancer surgery continued on our mixed hot and cold site through the establishment of a Super Green ERAS pathway. Patients were confirmed COVID-19 negative within 72 hours pre-admission and retested 72-hourly post-op. 14 days self-isolation pre-admission was mandated. Patients not complying had their surgery postponed. Transhiatal oesophagectomy was the preferred approach for oesophagectomy during the pandemic. Results 45 resections (33 oesophagectomies, 10 gastrectomies and 2 trial of dissections) were performed. 37 (82.2%) patients were male with a median age of 64 (IQR 58-71) years. 3 patients were postponed due to non-adherence with self-isolation. No patients tested positive for COVID-19 post-operatively, hence, there was no COVID-19-related morbidity. Nine patients developed pneumonia. Seven patients had an anastomotic leak, all of whom were successfully rescued. One patient required a clamshell thoracotomy due to intra-operative mediastinal bleeding followed by a return to theatre for reconstruction 48hrs later. Median length of stay was 12 (IQR 9-18) days. There was no in-hospital mortality. Conclusions OG cancer resections can be performed safely despite COVID-19, with favorable clinical outcomes when a Super Green ERAS pathway is strictly adhered to. Implementation of such pathways will enable surgical oncology services, including OG cancer resections, to continue to ensure best possible outcomes for cancer patients despite any future waves of the COVID-19 pandemic.

Transhiatal oesophagectomy: a single unit study

Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.

Total pharyngolaryngectomy with laparoscopic transhiatal oesophagectomy with gastric pull-up: a study of 13 cases

<p class="abstract"><strong>Background:</strong> Post cricoid cancers are known to be treated with total pharyngo-laryngo-oesophagectomy (TPLO) with several reconstructive procedures described. This study aims at clinical symptoms in patients having hypopharyngeal cancer who underwent total pharyngo-laryngectomy with laparoscopic transhiatal oesophagectomy (TPLO) with gastric pull-up (GPU).</p><p class="abstract"><strong>Methods:</strong> The clinical data of 13 patients undergoing TPLO with GPU during July 2013 to September 2017 were evaluated. All the patients had biopsy proven carcinoma. TPL was done and laparoscopic Transhiatal oesophagectomy was done and also the stomach was mobilized laparoscopically. The neostomach was delivered through posterior mediastinum and pharyngogastric anastomosis was done. </p><p class="abstract"><strong>Results:</strong> Only one patient (7%) had anastomotic stricture which required endoscopic dilatation, rest all the patients had no complications. So far they remain free of tumor recurrence or any other symptoms.</p><p class="abstract"><strong>Conclusions:</strong> Laparoscopic GPU in a patient of TPLO should be the procedure of choice for maintaining the continuity of alimentary tract.</p>