343. The Risk Factors of Hiatal Hernia in Esophageal Cancer Patients Who Received Gastric Interposition Through Posterior Mediastinal Route

Abstract

Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvement in survival. The aims of this study were to define the incidence, risk factors of HH in patients who underwent esophagectomy and reconstructed with gastric tube via posterior mediastinal route. We performed a monocentric retrospective study on 510 patients with esophageal cancer who underwent esophagectomy and reconstructed with the gastric substitute via posterior mediastinal route from 2007 to 2019. All postoperative computer tomography images were re-reviewed by two radiologists independently. The incidence of HH was estimated using Kalbfleisch and Prentice method and risk factors of HH were studied using the Fine and Gray competitive risk regression model by treating death as a competing event. A total of 27 developed HH with the two-year cumulative incidence of 5.3%. The median time to diagnosis was 297 days. HH were symptomatic in 14 patients (52%) in whom five required emergent repair. Among the 22 patients who were treated non-operatively, progression of HH was found in 9. In the multivariable analysis, the risk factors for HH were: laparoscopic gastric tube harvest (HR = 5.756[1.07 ~ 31.2], p = 0.042) and the use of preoperative therapy (HR = 2.714[1.03 ~ 7.14], p = 0.043) were identified as independent factors associated with increased risk of HH. HH represents a relevant surgical complication after esophagectomy and reconstructed with the gastric substitute via posterior mediastinal route. Especially in those who received preoperative therapy and using laparoscopic approach.