Cervical gastrostomy in the surgical treatment of oesophageal cancer by reconstruction with the stomach.

Abstract

A technique of cervical gastrostomy is described. Cervical gastrostomy as an alternative to the use of an indwelling nasogastric tube after cervical oesophagogastrostomy after resection for cancer has been used in six patients and appears to have certain advantages in terms of effective gastric decompression, avoiding discomfort to the patient, and simplification of postoperative nursing. It may play a significant role in reducing postoperative mortality from aspiration pneumonitis and other pulmonary complications.Recent advances in the surgical treatment of oesophageal cancer have led to a higher resectability and reduced postoperative mortality and morbidity rates. Among the most serious and frequent postoperative complications are anastomotic leaks and lung complications. Nowadays, leaks are less frequent as a result of better preoperative preparation, by parenteral feeding, by improved anastomotic techniques and the recent general tendency to perform total oesophagectomy followed by a cervical anastomosis. There are two reasons for this development. First, total oesophageal resection has reduced the incidence of local recurrence of the tumour from submucous longitudinal lymphatic spread. Second, there is the important observation that the mortality rate resulting from a fistula after cervical anastomosis is considerably less than that after an intrathoracic fistula. But postoperative lung complications, chiefly aspiration pneumonitis, also remain a major cause of postoperative difficulties. To a certain extent these can be prevented by better preoperative preparation, intensive pre-and postoperative thoracic physiotherapy and improved anaesthetic techniques,' but in spite of these measures, postoperative lung complications remain a significant cause of death. In a series of cases reported by Belsey, 15% of the operative fatalities resulted from aspiration pneumonitis (Belsey,

Transcervical Gastric Tube Drainage Facilitates Patient Mobility and Reduces the Risk of Pulmonary Complications After Esophagectomy

“…18 We also believe that effective decompression of the gastric conduit for a period of 5-7 days during the period of greatest gastric tip ischemia may also be beneficial in reducing anastomotic failure and postoperative anastomotic stricturing. 19 …”

Pharyngostomy tubes for gastric conduit decompression

“…Routine postoperative decompression of the upper gastrointestinal tract has long been the standard of care. [1][2][3] After esophagectomy, theoretic advantages include protection against aspiration and decreased risk of anastomotic leak from distention-induced gastric conduit ischemia. 6,7 NGT decompression is the mainstay of therapy for patients requiring decompression of the gastrointestinal tract; however, NGT decompression itself may provide an additional source of complications, including aspiration, associated pulmonary compromise, patient discomfort, and sinusitis.…”

“…Not only are NGTs uncomfortable, however, they contribute their own morbidity to the procedure, including sinusitis, pharyngitis, and aspiration events. 1,2 A pharyngostomy tube (PT), placed percutaneously through the lateral pharyngeal wall, is a safe but uncommonly used alternative to the NGT for gastric conduit decompression. [1][2][3] A PT offers certain potential advantages relative to the conventional NGT, including greater patient comfort, less interference with pulmonary toilet and patient mobility, and the possibility of prolonged use (several months if necessary).…”

“…1,2 A pharyngostomy tube (PT), placed percutaneously through the lateral pharyngeal wall, is a safe but uncommonly used alternative to the NGT for gastric conduit decompression. [1][2][3] A PT offers certain potential advantages relative to the conventional NGT, including greater patient comfort, less interference with pulmonary toilet and patient mobility, and the possibility of prolonged use (several months if necessary). In this study, we provide a detailed technical illustration of PT placement and briefly describe our clinical experience with PTs in esophagectomy patients.…”