Omentoplasty for esophagogastrostomy after esophagectomy

Yuan, Yong; Zeng, Xiaoxi; Hu, Yang; Xie, Ting; Zhao, Yaopeng

doi:10.1002/14651858.cd008446.pub2

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…For both treatment arms, an identical two-field lymphadenectomy is performed, and a gastric tube reconstruction with the gastric tube in the posterior mediastinum is used. An omental wrap is performed after IEA and CEA, since there is evidence that this reduces the incidence of clinically relevant anastomotic leakage [ 11 ]. Other surgical factors are left to the discretion of the surgeon.…”

Section: Methodsmentioning

confidence: 99%

Intrathoracic versus Cervical ANastomosis after minimally invasive esophagectomy for esophageal cancer: study protocol of the ICAN randomized controlled trial

Workum

Bouwense

Luyer

et al. 2016

Trials

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BackgroundCurrently, a cervical esophagogastric anastomosis (CEA) is often performed after minimally invasive esophagectomy (MIE). However, the CEA is associated with a considerable incidence of anastomotic leakage requiring reintervention or reoperation and moderate functional results. An intrathoracic esophagogastric anastomosis (IEA) might reduce the incidence of anastomotic leakage, improve functional results and reduce costs. The objective of the ICAN trial is to compare anastomotic leakage and postoperative morbidity, mortality, quality of life and cost-effectiveness between CEA and IEA after MIE.Methods/designThe ICAN trial is an open randomized controlled multicentre superiority trial, comparing CEA (control group) with IEA (intervention group) after MIE. All patients with esophageal cancer planning to undergo curative MIE are considered for inclusion. A total of 200 patients will be included in the study and randomized between the groups in a 1:1 ratio. The primary outcome is anastomotic leakage requiring reintervention or reoperation, and secondary outcomes are (amongst others) other postoperative complications, new onset of organ failure, length of stay, mortality, benign strictures requiring dilatation, quality of life and cost-effectiveness.DiscussionWe hypothesize that an IEA after MIE is associated with a lower incidence of anastomotic leakage requiring reintervention or reoperation than a CEA. The trial is also designed to give answers to additional research questions regarding a possible difference in functional outcome, quality of life and cost-effectiveness.Trial registrationNetherlands Trial Register: NTR4333. Registered on 23 December 2013.

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Section: Methodsmentioning

confidence: 99%

Intrathoracic versus Cervical ANastomosis after minimally invasive esophagectomy for esophageal cancer: study protocol of the ICAN randomized controlled trial

Workum

Bouwense

Luyer

et al. 2016

Trials

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“…The review indicated that more randomized trials were needed. [16] In keeping with this finding, the most recent randomized trial on the topic was published in 2013 by Zheng and colleagues with 184 patients randomized to omentoplasty (n=92) or non-omentoplasty (n=92). [17] Similar to Bhat and Dai, they observed a significant reduction in leak rate (9.8% vs 3.3%; p<0.05).…”

Section: Prophylactic Management Of Anastomotic Leak After Esophagectmentioning

confidence: 99%

Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

Schaheen

Blackmon

Nason

2014

The American Journal of Surgery

101

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Background Recently, endoscopic interventions, e.g. esophageal stenting, have been successfully utilized for the management of intrathoracic leak. The purpose of this systematic review was to assess the safety and efficacy of techniques used in the management of intrathoracic anastomotic leak. Data Sources We performed a systematic review of MEDLINE, EMBASE, and PubMed to identify eligible studies analyzing management of intrathoracic esophageal leak following esophagectomy. Conclusions Intraoperative anastomotic drain placement was associated with earlier identification and resolution of anastomotic leak (mean 23.4 vs 80.7 days). In addition, reinforcement of the anastomosis with omentoplasty may reduce the incidence of anastomotic leak by nearly 50%. Endoscopic stent placement was associated with leak resolution in 72%; fatal complications were reported, however, and safety remains to be proven. Negative pressure therapy, a potentially useful tool, requires further study. If stenting and wound vacuum are used, undrained mediastinal contamination and persistent leak requires surgical intervention.

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“…An additional meta‐analysis found that linear stapling was associated with reduced stricture risk compared with hand‐sewing cervical anastomoses; an effect which may have been mediated by reduced anastomotic leak rates post‐stapled anastomosis in the included studies [45]. Further technical considerations which may modify anastomotic complications include end‐to‐side or side‐to‐side stapled or the semi‐mechanical Collard esophagogastric anastomosis [11, 46, 47], and routine use of omentoplasty, which has been associated with reduced leak rates in a recent Cochrane review [48]. All procedures included in this series were performed using an open approach.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Anastomotic Stricture Post‐esophagectomy with a Standardized Sutured Anastomosis

et al. 2016

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Omentoplasty for esophagogastrostomy after esophagectomy

Cited by 6 publications

References 35 publications

Intrathoracic versus Cervical ANastomosis after minimally invasive esophagectomy for esophageal cancer: study protocol of the ICAN randomized controlled trial

Intrathoracic versus Cervical ANastomosis after minimally invasive esophagectomy for esophageal cancer: study protocol of the ICAN randomized controlled trial

Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

Risk Factors for Anastomotic Stricture Post‐esophagectomy with a Standardized Sutured Anastomosis

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