Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group

Palmes, Daniel; Brüwer, M.; Bader, Franz G.; Betzler, M; Becker, Heinz; Bruch, Hans‐Peter; Büchler, Markus W.; Buhr, H. J.; Ghadimi, B. M.; Hopt, Ulrich T.; Konopke, Ralf; Ott, Katja; Post, Stefan; Ritz, Jörg‐Peter; Ronellenfitsch, Ulrich; Saeger, Hans‐Detlev; Senninger, N.

doi:10.1007/s00423-011-0818-3

Cited by 22 publications

(15 citation statements)

References 68 publications

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“…Due to the fact that anastomosis mortality in thorax is more than cervical anastomosis, average length of stay for patients who are hospitalized for thoracic anastomosis, especially in the ICU, is more than those with anastomosis in the neck (16). Treatment of fistula and anastomotic leak without symptoms of mediastinitis and Sepsis is conservative containing the appropriate antibiotic through feeding tube into the esophagus (17). For discharge drainage, if there is not enough drain, it will be possible to insert extra drain for better drainage (18).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Mousavi¹,

Akbari²

2017

Int J Cancer Manag

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Background: Due to the high prevalence and mortality rates of esophageal cancer in some parts of the world and considering that in most patients, symptoms occur when cancer is advanced, this study aimed to compare early and late complications in three esophagectomy techniques for treatment of esophageal cancer. Methods: The present study was a descriptive research on 316 patients with esophageal cancer referring to Shohada Tajrish hospital, Tehran. The results were recorded in the research forms consisting of individual characteristics, symptoms and reasons for referring to the hospital. Findings were extracted after classification and evaluated using descriptive statistics. Results: Among 316 patients studied, 190 patients (60%) were male and 126 (40%) were female. The highest prevalence was between 40 and 60 years old. The most significant reason for referring to the hospital was dysphagia and weight loss. Among 260 patients, 72 patients (27.7%) underwent surgery by transthoracic (Ivor Lewis type) approach, 76 patients (29.2%) underwent surgery by threeincision approach (Mc Keown procedure), and 112 patients (43%) underwent surgery by Trans-Hiatal (Oringer). A total of 36 deaths occurred. 22 deaths occurred using Ivor-Lewis (61%), 10 deaths occurred using Mc Keown (27.7%) and 4 deaths occurred after Oringer (11.1%). In terms of prevalence of complications, the most common early complication was pleural effusion (11%) and the most common late complication was anastomotic stricture (17.8%). Conclusions:Complications occurred in all three surgeries. The most complications occurred using transthoracic (Ivor Lewis type) approach and the least complications occurred using Trans-Hiatal (Oringer).

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Section: Discussionmentioning

confidence: 99%

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Mousavi¹,

Akbari²

2017

Int J Cancer Manag

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“…If an anastomotic leakage was suspected, endoscopy was performed immediately. 9 The diagnosis of AF was based on endoscopic and bronchoscopic verification of a fistula between upper intestinal tract and airways.…”

Section: Standard Surgical Procedures and Postoperative Coursementioning

confidence: 99%

Potential risk factors and outcomes of fistulas between the upper intestinal tract and the airway following Ivor-Lewis esophagectomy

Lindner

Lübbe

Müller

et al. 2016

Diseases of the Esophagus

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Fistulas between the upper intestinal tract and the airway following esophagectomy are a rare and severe complication with significant mortality. Treatment and therapy are difficult and require a multidisciplinary approach. The objective of this retrospective study was to identify risk factors for these fistulas following esophagetcomy, and to assess their impact on the further clinical course and outcome. 211 patients undergoing Ivor-Lewis esophagectomy for esophageal cancer between 2005 and 2012 were included. The preoperative risk factors including the risk score according to Schröder et al. and the O-Physiological and Operative Severity Score (POSSUM) score, operative and postoperative parameters and the outcome were evaluated. 65% of all patients developed postoperative complications, including 12 patients that developed fistulas between the upper intestinal tract and the airway (airway fistulas [AF]; 5.6%). Neither patient related risk factors nor esophagus-specific risk scores correlated with occurrence of AF. Furthermore, surgical treatment and neoadjuvant treatment did not show any effect on development of AF in our patients. However, we could demonstrate that AF significantly impacted on length of hospital stay (AF 52 days vs. No-AF group 16 days, P < 0.001), incidence of major pulmonary complications (83.3% vs. 17.1%, P < 0.001), 90-day mortality (42% vs. 7.5%, P = 0.002) and overall survival (133 days vs. 636 days, P=0.029). With the current study, we could not identify any patient related risk factors, esophagus-specific risk scores or treatment related details that might be useful as predictors of AF after Ivor-Lewis esophagectomy. However, we confirmed that AF significantly impacted on outcomes. This highlights the urgent need for further studies on this rare but devastating complication after esophagectomy.

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“…In case of suspected anastomotic insufficiency, an endoscopic examination was performed, and either an interventional treatment such as stent implantation or re-operation was carried out. Pneumonia was treated with antibiotics and intensified pulmonary exercises [23] .…”

Section: Treatment Protocolmentioning

confidence: 99%

Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma

Lindner

Palmes²,

Grübener³

et al. 2015

Dig Surg

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Background/Aims: Surgery for esophageal cancer is associated with a high morbidity and mortality. With this study, we investigated if a validated preoperative risk score correlates with overall morbidity, mortality, anastomotic insufficiency, respiratory complications and with the severity of complications after open Ivor-Lewis esophagectomy. Methods: A total of 94 patients undergoing esophageal resection for adenocarcinoma between 2005 and 2009 were included. Patients were assigned using the preoperative risk score according to Schröder et al. [Langenbecks Arch Surg 2006;391:455-460] and the Dindo classification regarding the severity of complications. Results: Of all the patients, 12% had a ‘normal', 54% a ‘moderateʼ and 34% a ‘high' preoperative risk score. Postoperative complications occurred in 79%. Furthermore, 36 or 21 or 14 or 7% of patients experienced complications of category I/II or III or IV or V, respectively. There was a significant association between preoperative risk score and overall morbidity (p = 0.010), mortality (p = 0.035) and anastomotic insufficiency (p = 0.023). Furthermore, higher preoperative risk score was significant related to increasing severity of postoperative complications (grade IV according to the Dindo classification: p = 0.018, Dindo grade V: p = 0.035). Neoadjuvant therapy consisting of cisplatin and 5-fluorouracil had no influence. Conclusion: As we demonstrated, a significant association between preoperative risk score and occurrence and severity of postoperative complications after open Ivor-Lewis esophagectomy, standardized, organ-specific pre- and postoperative categorizations might be useful for individual clinical decision making in this group of patients.

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Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group

Abstract: The GAST consensus statement represents a position paper for treatment of patients with esophageal carcinoma which both contributes to the development of clinical treatment guidelines and outlines topics in need of further clinical studies.

Cited by 22 publications

References 68 publications

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Potential risk factors and outcomes of fistulas between the upper intestinal tract and the airway following Ivor-Lewis esophagectomy

Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma

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