Intrathoracic versus Cervical Anastomosis after Resection of Esophageal Cancer: A matched pair analysis of 72 patients in a single center study

Abstract

BackgroundThe aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study.Methods72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates.ResultsAnastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11%) vs. 11 of 36 patients (31%); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10–110) vs. 26 days (range 12 – 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046). The overall In-hospital mortality rate was 6% (4 of 72 patients) without any differences between the study groups.ConclusionsThe present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.

C-reactive protein for the early prediction of anastomotic leak after esophagectomy in both neoadjuvant and non-neoadjuvant therapy case: a propensity score matching analysis

“…In this study, NT did not increase the risk of anastomotic leak. In addition, the prevalence of anastomotic leak did not differ between intrathoracic and cervical anastomoses (2,20,21). Furthermore, CRP did not differ regardless of NT or anastomosis type.…”

Chirurgische Therapie des Ösophaguskarzinoms

“…Bei thorakoabominellem Vorgehen wurde im untersuchten Kollektiv routinehaft eine 2-Feld-Lymphadenektomie durchgeführt [14].…”

“…CA Karzinom difizierte chirurgische Therapie des Öso-phaguskarzinoms. Die Wahl des operativen Zuganges zur Ösophagusresektion (transhiatal vs. thorakoabdominal) war historisch stets eine Abwägung zwischen erhöhter perioperativer Morbidität und radikalerem onkologischen Vorgehen [14]. Bereits 2007 konnte gezeigt werden, dass die transhiatale Ösophagusresektion keine Vorteile in Bezug auf die perioperative Morbidität hat [6,22].…”

“…Bereits ab 2001 lässt sich ein Abfall der pulmonalen Morbidität von durchschnittlich 62 auf 37% und gleichzeitig eine deutliche Reduktion der Mortalität beobachten. Diese Fortschritte sind am ehesten auf eine Optimierung der anästhesiolo-gischen und intensivmedizinischen Be- [13,14]. Dieser Effekt konnte in Metaanalysen jedoch bisher nicht bestätigt werden [4].…”

Application of Oesophagogastric Cervical Mechanical Anastomosis in Oesophagectomy for Cancer

“…Patients that underwent cervical anastomosis have better postoperative quality of life than those that received intrathoracic anastomosis. Therefore, cervical anastomosis has been widely applied clinically and accepted by thoracic surgeons [3][4][5][6].…”