Management of delayed gastric conduit emptying after esophagectomy

Zhang, Rusi

doi:10.21037/jtd.2018.11.101

Cited by 13 publications

(8 citation statements)

References 37 publications

(40 reference statements)

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“…Independent from the kind of neoadjuvant therapy it is due to the radical nature of the surgery that a vagotomy is often inevitable and, therefore, the parasympathetic effects of the vegetative nervous system can no longer affect the function of the pylorus. Still today this is a common circumstance directly influencing the patients’ postsurgical gastrointestinal function and quality of life (Maus et al 2016 ; Zhang and Zhang 2019 ; Yang et al 2020 ). However, to our best knowledge, there are almost no data available so far focusing on this important issue.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

Plum

Damanakis

Buschmann³

et al. 2021

J Cancer Res Clin Oncol

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Background Patients with locally advanced esophageal or gastroesophageal adenocarcinoma benefit from multimodal therapy concepts including neoadjuvant chemoradiation (nCRT), respectively, perioperative chemotherapy (pCT). However, it remains unclear which treatment is superior concerning postoperative morbidity. Methods In this study, we compared the postsurgical survival (30-day/90-day/1-year mortality) (primary endpoint), treatment response, and surgical complications (secondary endpoints) of patients who either received nCRT (CROSS protocol) or pCT (FLOT protocol) due to esophageal/gastroesophageal adenocarcinoma. Between January 2013 and December 2017, 873 patients underwent Ivor Lewis esophagectomy in our high-volume center. 339 patients received nCRT and 97 underwent pCT. After 1:1 propensity score matching (matching criteria: sex, age, BMI, ASA score, and Charlson score), 97 patients per subgroup were included for analysis. Results After matching, tumor response (ypT/ypN) did not differ significantly between nCRT and pCT (p = 0.118, respectively, p = 0.174). Residual nodal metastasis occurred more often after pCT (p = 0.001). Postsurgical mortality was comparable within both groups. No patient died within 30 or 90 days after surgery while the 1-year survival rate was 72.2% for nCRT and 68.0% for pCT (p = 0.47). Only grade 3a complications according to Clavien–Dindo were increased after pCT (p = 0.04). There was a trend towards a higher rate of pylorospasm within the pCT group (nCRT: 23.7% versus pCT: 37.1%) (p = 0.061). Multivariate analysis identified pCT, younger age, and Charlson score as independent variables for pylorospasm. Conclusion Both nCRT and pCT are safe and efficient within the multimodal treatment of esophageal/gastroesophageal adenocarcinoma. We did not observe differences in postoperative morbidity. However, functional aspects such as gastric emptying might be more frequent after pCT.

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Section: Discussionmentioning

confidence: 99%

Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

Plum

Damanakis

Buschmann³

et al. 2021

J Cancer Res Clin Oncol

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“…Performing a pyloroplasty acts to widen the gastric outlet, allowing the gastric contents to pass through more easily and thus in theory remove any pyloric obstruction that may occur as a result of the esophagectomy. 7 However, there is ongoing controversy as to whether pyloric drainage procedures are necessary, especially when DGCE can be managed with Botox injection or corrective pyloroplasty post-operatively. 5,8,9 There is also further debate as to whether the adverse effects of pyloroplasty itself outweigh any clinical benefit.…”

Section: Introductionmentioning

confidence: 99%

“…Various long-term complications of performing pyloroplasty related to the absence of an intact pylorus have been reported, including dumping syndrome and bile reflux. 3,7,10…”

Section: Introductionmentioning

confidence: 99%

“…Various long-term complications of performing pyloroplasty related to the absence of an intact pylorus have been reported, including dumping syndrome and bile reflux. 3,7,10 There is a distinct lack of both global and national guidelines on the role of pyloroplasty, leaving the choice of whether to perform pyloric drainage procedures largely up to the preference of the surgeon. The aim of this study was to investigate the outcomes of pyloroplasty following esophagectomy for cancer.…”

Section: Introductionmentioning

confidence: 99%

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Pyloroplasty Reduces the Need for Pyloric Dilatation After Esophagectomy

Han

Halle‐Smith

et al. 2023

Foregut: The Journal of the American Foregut Society

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Background: Delayed gastric conduit emptying (DGCE) is a recognized complication of esophagectomy which can lead to prolonged vomiting, aspiration, and reduced oral intake postoperatively. To minimize the risk of DGCE, some advocate the use of pyloroplasty, however the practice is varied and controversial. The aim of this study is to investigate the effect of pyloroplasty on DGCE in esophagectomy patients. Methods: Consecutive patients that underwent an esophagectomy for esophageal cancer from September 2011 to December 2020 were identified from a prospectively maintained departmental cancer database at our institution. The primary outcome measured was the need for pyloric intervention following esophagectomy. Secondary outcomes included cardiac complications, pulmonary complications, anastomotic leaks, and chyle leaks. For those who had contrast swallow tests done prior to discharge from the index admission, dilated conduit and delayed gastric emptying were also investigated. Results: Of 458 patients included in the study, 77(17%) underwent pyloroplasty. Of the 381 patients who underwent esophagectomy without pyloroplasty, 44 (12%) of these patients later required at least one pyloric dilatation. None of the patients who underwent pyloroplasty later required pyloric dilatation. On multivariate analysis, younger age, respiratory complications after esophagectomy and pyloroplasty were significant predictors of the need for pyloric dilatation. Pyloroplasty was not significantly related to dilated conduit or delayed emptying on contrast swallow with P value of 0.979 and 0.147, respectively. Conclusions: Pyloroplasty reduces the need for pyloric dilatation postoperatively. However, further research is required to investigate the nature of this relationship, specifically in terms of contrast swallow.

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“…2,3 Unfortunately, current literature is limited and unable to corroborate the optimal MIE approach (with or without addition of a drainage procedure) or accurately predict those at risk for DGCE pre-operatively. 2,3 To address this issue, Han et al present their well-written retrospective study evaluating the role of adjunct pyloroplasty at the time of esophagectomy. 2 As pyloroplasty consists of the surgical technique of widening the gastric outlet, some surgeons have advocated for its adjunct use during esophagectomy to decrease the incidence of DGCE.…”

mentioning

confidence: 99%