Combat with esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer: A critical review of the literature

Abstract

Esophagojejunal anastomotic leakage (EJAL) is considered to be one of the most serious complications after total gastrectomy (TG), despite improvements in surgical instruments and technique. The occurrence of EJAL would cause poorer quality of life, prolonged hospital stay, and increased surgery-related costs and mortality. Although there is ever-increasing knowledge about EJAL, the optimal management is controversial. In the present review, we aim to demonstrate the effective management by focus on the possible risk factors, potentially useful preventive strategies, and several kinds of treatments in esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer.

Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

“…Moreover, Kim et al [21] reported that the incidence of anastomotic leakage was significantly higher for TG than for SG. The reported rates of anastomotic leakage after TG vary from 4 to 15% [22]. In our study, the only three patients to exhibit anastomotic leakage were in the TG group, which may reflect an advantage of SG.…”

Combined Endoscopic Negative Pressure and Surgical Treatment of Anastomotic Insufficiencies following Oncological Gastrectomy – Recent Results

“…Several articles favor the primary use of self-expandable fully or partially covered metal stents or sealing the leak with clips in patients with EJAL [3,[17][18][19][20]. Both techniques lead to a more or less closing of the defect without addressing the extraluminal infected focus or uid collection.…”

“…For subtotal and complete gastrectomy, the digestive reconstruction is performed with a Roux-en-Y or jejunal interposition, both of which include anastomosis between the esophagus/stomach remnant and jejunum. Esophagojejunal anastomotic leakage (EJAL) is still one of the most serious complications with an EJAL incidence between 0.5% and 11.0% associated with a high mortality rate [1][2][3].…”

Причины Несостоятельности Швов Анастомозов После Гастрэктомии

“…Материалы и методы Технические причины несостоятельности швов анастомоза общеизвестны: натяжение тканей [8,9,14,15], плохая адаптация сшиваемых поверхностей [8,9], прорезывание скобок после извлечения сшивающих аппаратов [12,15], неумелое применение сшивающих аппаратов и неправильный уход за ними [15,16], нарушение кровоснабжения на уровне сшиваемых отрезков пищеварительного тракта [1, 8, 9, 16,], наложение швов по ходу основного продольного слоя мышц пищевода [16], что приводит к прорезыванию швов, травмам поджелудочной железы, в результате чего происходит истечение агрессив-ного содержимого из поврежденной или резецированной поджелудочной железы [9], что приводит к инфицированию линии швов анастомоза [8,12], а также некротическим и воспалительным процессам [17], наложение швов на пораженный участок стенки пищевода, также часто приводит к несостоятельности пищеводно-кишечного анастомоза [12,14]. Многочисленными исследованиями доказано, что одной из основных причин несостоятельности швов пищеводно-кишечного анастомоза является лимфодиссекция в объеме D2.…”

“…Materials and methods. Technical causes of anastomotic leakage are well known: tension of tissues [8,9,14,15], poor adaptation of a stitched surfaces [8,9], eruption of staples after removal of suturing devices [12,15], the inept application of suturing devices and improper care of them [15,16], blood supply disturbance at the level of the sewing segments of the digestive tract [1,8,9,16], suturing along the main longitudinal layer of the esophagus muscles [16], which leads to the eruption of sutures, pancreatic injuries, resulting in the outflow of aggressive contents from the damaged or resected pancreas [9], which leads to the infection of anastomosis suture line [8,12], as well as necrotic and inflammatory processes [17], suturing of the affected area of the esophageal wall, also often leads to esophagointestinal anastomotic leakage [12,14]. Numerous studies have shown that one of the main causes of esophagointestinal anastomotic leakage is lymph node dissection in D2 volume.…”