Anastomotic stricture after Ivor Lewis esophagectomy: An evaluation of incidence, risk factors, and treatment

Koshy, Renol; Brown, Joshua; Chmelo, Jakub; Watkinson, Thomas; Phillips, Alexander W

doi:10.1016/j.surg.2021.07.034

Cited by 3 publications

(3 citation statements)

References 31 publications

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“… 15 , 17 , 18 However, other factors, included in the current study, such as postoperative delirium, adhesion of the thoracic cavity at the operative side, WBC count of the whole blood after the operation and lymphocyte count after the operation, are rarely considered. 19 , 20 Some patients with postoperative delirium do not cooperate with postoperative recovery, and can be prone to hypoxemia. This could impair the diffusion function of the patient’s lungs, resulting in organ and tissue hypoxia or even respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Su¹,

Huang²,

Lv³

et al. 2023

Pak J Med Sci

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Objective: To explore the risk factors of anastomotic leakage after minimally invasive esophagectomy (MIE) and to build a prediction model of the probability of postoperative anastomotic leakage. Methods: Clinical data of patients undergoing MIE, admitted in the Fourth Hospital of Hebei Medical University from March 2018 to March 2022, were retrospectively selected, and risk factors of anastomotic leakage after MIE were analyzed by univariate and multivariate logistic regression. A prediction nomogram model was established based on the independent risk factors, and its prediction effect was evaluated. Results: A total of 308 patients were included. Thirty patients had postoperative anastomotic leakage, with an incidence of 9.74%. Logistic regression analysis showed that age, postoperative delirium, pleural adhesion, postoperative pulmonary complications, high postoperative white blood cell count and low lymphocyte count were risk factors for postoperative anastomotic leakage. A nomograph prediction model was constructed based on these risk factors. The predicted probability of occurrence of the nomograph model was consistent with the actual probability of occurrence. The calculated C-index value (Bootstrap method) was 0.9609, indicating that the nomograph prediction model had a good discrimination ability. By drawing the receiver operating characteristic (ROC) curve, we showed that the area under the curve (AUC) of the nomograph prediction model was 0.9609 (95%CI: 0.937-0.985), which indicated a good prediction efficiency of the model. Conclusions: The nomograph prediction model based on the independent risk factors of anastomotic leakage after MIE can accurately predict the probability of postoperative anastomotic leakage. doi: https://doi.org/10.12669/pjms.39.5.8050 How to cite this: Su P, Huang C, Lv H, Zhang Z, Tian Z. Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.8050 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Su¹,

Huang²,

Lv³

et al. 2023

Pak J Med Sci

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“…25,26 Risk factors for stricture formation include male gender, occurrence of anastomotic leaks, small (less than 28 mm) circular staple size, proximal esophageal tumors, and longer width of the gastric tube (5 cm vs 3 cm). [26][27][28] While approximately 5% of patients have refractory strictures not amenable to endoscopic therapy, the majority of these patients are successfully managed with endoscopic dilation, though multiple procedures may be required for long-lasting effect (Figure 2). 27 For patients with refractory anastomotic strictures, self-dilation is an option to reduce the frequency of endoscopic dilations and improve quality of life.…”

Section: Anastomotic Stricturesmentioning

confidence: 99%

“…Clinically relevant anastomotic strictures (manifesting with dysphagia or inability to pass a standard adult gastroscope) complicate 10% to 30% of esophagectomies with gastric pull-ups. 25,26 Risk factors for stricture formation include male gender, occurrence of anastomotic leaks, small (less than 28 mm) circular staple size, proximal esophageal tumors, and longer width of the gastric tube (5 cm vs 3 cm). [26][27][28] While approximately 5% of patients have refractory strictures not amenable to endoscopic therapy, the majority of these patients are successfully managed with endoscopic dilation, though multiple procedures may be required for long-lasting effect (Figure 2).…”

Section: Anastomotic Stricturesmentioning

confidence: 99%

The Unhappy Gastric Conduit: A Medical Perspective

Codipilly

Snyder

2022

Foregut: The Journal of the American Foregut Society

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The gastric conduit is commonly created after esophagectomy to restore intestinal continuity. In this review, we discuss several complications that can arise and can be managed by a gastroenterologist. We highlight endoscopic management of anastomotic leaks and strictures. We also describe the work up and management of reflux disease, delayed gastric conduit emptying, and dumping syndrome, all of which can complicate short- and long-term outcomes in patients receiving a gastric conduit.

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Esophageal Anastomoses: Bigger Is Still Usually Better

Fox¹

2023

The Annals of Thoracic Surgery

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Anastomotic stricture after Ivor Lewis esophagectomy: An evaluation of incidence, risk factors, and treatment

Cited by 3 publications

References 31 publications

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy

The Unhappy Gastric Conduit: A Medical Perspective

Esophageal Anastomoses: Bigger Is Still Usually Better

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