Improved Functional Results After Minimally Invasive Esophagectomy: Intrathoracic Versus Cervical Anastomosis

Workum, Frans van; Maas, J.; Wildenberg, Frits J. H. van den; Polat, Fatih; Kouwenhoven, Ewout A.; Det, Marc J. van; Nieuwenhuijzen, Grard A. P.; Luyer, Misha; Rosman, Camiel

doi:10.1016/j.athoracsur.2016.07.010

Cited by 99 publications

(64 citation statements)

References 26 publications

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“…Although the anastomotic leak rate was lower in patients with an intrathoracic anastomosis, and this may appear the preferred location of the oesophagogastric anastomosis, leak rates in the present study are high compared with those in other studies 5,9 . Leak rates after an intrathoracic and cervical anastomosis range from 9 to 21 per cent 9,17,29,30 and 8 to 35 per cent 9,17,29,31 respectively. Some studies included only clinically relevant or radiologically proven anastomotic leaks, whereas others included both 32 .…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer

Gooszen

Goense

Gisbertz

et al. 2018

British Journal of Surgery

121

104

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BackgroundStudies comparing the anastomotic leak rate in patients with an intrathoracic versus a cervical anastomosis after oesophagectomy are equivocal. The aim of this study was to compare clinical outcome after oesophagectomy in patients with an intrathoracic or cervical anastomosis, and to identify predictors of anastomotic leakage in a nationwide audit.MethodsBetween January 2011 and December 2015, all consecutive patients who underwent oesophagectomy for cancer were identified from the Dutch Upper Gastrointestinal Cancer Audit. For the comparison between an intrathoracic and cervical anastomosis, propensity score matching was used to adjust for potential confounders. Multivariable logistic regression modelling with backward stepwise selection was used to determine independent predictors of anastomotic leakage.ResultsSome 3348 patients were included. After propensity score matching, 654 patients were included in both the cervical and intrathoracic anastomosis groups. An intrathoracic anastomosis was associated with a lower leak rate than a cervical anastomosis (17·0 versus 21·9 per cent; P = 0·025). The percentage of patients with recurrent nerve paresis was also lower (0·6 versus 7·0 per cent; P < 0·001) and an intrathoracic anastomosis was associated with a shorter median hospital stay (12 versus 14 days; P = 0·001). Multivariable analysis revealed that ASA fitness grade III or higher, chronic obstructive pulmonary disease, cardiac arrhythmia, diabetes mellitus and proximal oesophageal tumours were independent predictors of anastomotic leakage.ConclusionAn intrathoracic oesophagogastric anastomosis was associated with a lower anastomotic leak rate, lower rate of recurrent nerve paresis and a shorter hospital stay. Risk factors for anastomotic leak were co‐morbidities and proximal tumours.

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Section: Discussionmentioning

confidence: 99%

Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer

Gooszen

Goense

Gisbertz

et al. 2018

British Journal of Surgery

121

104

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“…Anastomotic leakage after esophageal resection is one of the most feared postoperative complications, occurring in 5-20% of cases, 1,2 and can result in 30-day mortality of 2.1-35.7%. 3,4 Reasons for the gravity of these complications are both the anatomy of the esophagus and the location of the anastomosis. A recent meta-analysis including nearly 3000 patients showed worse long-term prognosis in patients with severe leakage after esophagectomy.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis, assessment, and management of surgical complications following esophagectomy

Grimminger

Goense

Gockel

et al. 2018

Annals of the New York Academy of Sciences

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“…La tasa de reoperaciones fue de un 11,7%, siendo en todas secundario a ascensos mediastínicos posteriores, de estas fueron 3 casos de aseos vídeo-toracoscópicos y una reparación de vena innominada. No existió diferencia estadística entre las vías de ascenso y la tasa de rev Chil Cir 2018;70(1): [19][20][21][22][23][24][25][26] eVolUCión y PronóStiCo onCológiCo de fíStUlaS anaStoMótiCaS eSofágiCaS y CánCer de eSófago -i. braghetto M. et al…”

Section: Introductionunclassified

Evolución y pronóstico oncológico de fístulas anastomóticas esofágicas en el tratamiento del cáncer de esófago. Estudio comparativo según vía de ascenso de tubo gástrico

et al. 2018

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Improved Functional Results After Minimally Invasive Esophagectomy: Intrathoracic Versus Cervical Anastomosis

Cited by 99 publications

References 26 publications

Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer

Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer

Diagnosis, assessment, and management of surgical complications following esophagectomy

Evolución y pronóstico oncológico de fístulas anastomóticas esofágicas en el tratamiento del cáncer de esófago. Estudio comparativo según vía de ascenso de tubo gástrico

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