Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition1

Briel, J. W.; Tamhankar, Anand P.; Hagen, Jeffrey A.; DeMeester, Steven R.; Johansson, Jan; Choustoulakis, Emmanouel M.; Peters, Jeffrey H.; Bremner, Cedric G.; DeMeester, Tom R.

doi:10.1016/j.jamcollsurg.2003.11.026

Cited by 341 publications

(262 citation statements)

References 7 publications

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“…Gabor et al (2005) reported that patients in their combined group had a shorter stay on the intensive care unit and in the hospital overall, however, what is striking in this study is the extremely high anastomotic leak rate (48% for combined routes and 52% parenteral nutrition alone). The accepted anastomotic leak rate in oesophagectomy is less than 20,% (Briel et al 2004;Ercan et al, 2005;Law et al, 2005) raising concerns regarding the external validity of this study.…”

Section: Enteral Vs Parenteral Nutritionmentioning

confidence: 91%

Nutritional access routes following oesophagectomy—a systematic review

2011

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Section: Enteral Vs Parenteral Nutritionmentioning

confidence: 91%

Nutritional access routes following oesophagectomy—a systematic review

2011

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“…Once anastomotic leakage develops, patients' internal environment will be disturbed and their nutritional status will get worse and worse, if diagnosed and treated improperly. Clinical manifestations indicating an anastomotic leakage after surgical resection of esophagogastric junction cancer varies greatly, depending on the size of the leakage and the severity of chest infection (8). Any of the following symptoms and signs such as persistent hyperpyrexia, newly occurred chest pain, chest distress, tachypnea or even a secondary respiratory failure, supraventricular tachycardia, and atrial fibrillation, alert us to the possible presence of an anastomotic leakage and more attention should be paid to the patients.…”

Section: Discussionmentioning

confidence: 99%

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Ding

Mao

et al. 2017

J. Thorac. Dis.

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Background: It was reported in the literatures that the incidence of anastomotic leakage in patients with esophagogastric junction cancer decreased due to application of staplers and closure devices as well as gastric conduit technique in recent years, however, it increased slightly at our center since widely using the above devices and gastric conduit techniques from 2009. The objective of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection in recent 6 years. Methods: All patients who received surgical resections for esophagogastric junction cancer and diagnosed anastomotic leak at our center between January 2009 and December 2014 were retrospectively analyzed, we also enrolled the patients who had a longer hospital stay (>30 days) as they may develop anastomotic leak. The binary logistic regression in SPSS 16.0 was applied to analyze the factors that may affect leakage healing. Results: Of the 1,815 surgically treated esophagogastric junction cancer patients, 91 cases were diagnosed anastomotic leakage postoperatively. The patients were divided into two groups based on the median leakage healing time (40 days) in this series: fast healing group (37 cases) and slowly healing group (54 cases). All factors that may affect the leakage healing were put into analysis by using binary logistic regression. The results of the analysis showed that leakage size (OR =1.073, P=0.004), thoracic drainage (OR =12.937, P=0.037) and smoking index ≤400 (OR =1.001, P=0.04) significantly affected the healing time, while drinking history (P=0.177), duration of fever after anastomotic leak developed (P=0.084), and hypoproteinemia after leak (P=0.169) also apparently but not significantly affect the healing time.Conclusions: Though many factors may affect leakage healing in the esophagogastric junction carcinoma patients, leakage size, thoracic drainage and smoking index (≤400) are the most important factors affecting the leakage healing. Placement of a chest tube beside the anastomosis area during operation for early identification and control of an anastomotic leak to minimize contamination of the mediastinum is the most important way to promote leakage healing. A chest tube placing into the purulent cavities after the patients experienced leaks is also important for the cure of leakage. More attention should be paid perioperatively to the patients who had a smoking index (≥400) and the patients who suffered fever or hypoproteinemia.

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“…This was confirmed by Moorehead and Wong in a sample of 760 esophagectomies: gastroplasty ischemia was described in 0.5%, in cases of jejunal interposition in 11.3% and in patients with coloplasty in 13.3% (ref. 14,15 ). Necrosis of the transposition is characterized by a total alteration of the state of the patients (unexpected tachycardia, respiratory failure, increase in inflammatory factors, lactate increase).…”

Section: Discussionmentioning

confidence: 99%

Esophagectomy for esophageal carcinoma - surgical complications and treatment

Vrba¹,

Aujeský²,

Hrabalová³

et al. 2012

BIOMED PAP

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Aim. To describe our experience with esophagectomy for esophageal cancer and, the development and treatment of complications arising from the surgery. Material and methods. From 2007 to 8/2010, esophagectomy for esophageal carcinoma was performed in 75 patients at the 1 st Surgical Clinic. Primary esophagectomy was indicated in 20 patients with T1N0 stage or in cases where neoadjuvant treatment was contraindicated. 55 patients with T2,3N0,1 stages received neoadjuvant radiochemotherapy. Esophagectomy was performed via an abdominal approach (transhiatal laparoscopy in 44 patients, laparotomy in 3 patients) and a thoracic approach (thoracoscopy in 10 patients, thoracotomy in 18 patients).Results. In 18 cases, one or both pleural cavities were opened by means of dissection of the mediastinal pleura during the transhiatal laparoscopic esophagectomy. The morbidity was 26.6% and the following complications were encountered: pulmonary (15 patients), anastomosis dehiscence (5), postoperative bleeding in the mediastinum (1), fistula between trachea and transposition (1), paresis of the left recurrent nerve (8), infectious complications in the abdominal cavity (2), thoracic cavity (1), and early complications (2). The sixty-day mortality was 8% and this was mostly due to pulmonary complications (4 patients) but included coronary thrombosis (1) and transposition necrosis (1). Conclusion. The dominating complications of esophagectomy were pulmonary (20 %). The remaining serious complications cannot be completely eliminated but if diagnosed in time and treated in a correct algorithm they do not have to imminently threaten the lives of patients.

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Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition1

Cited by 341 publications

References 7 publications

Nutritional access routes following oesophagectomy—a systematic review

Nutritional access routes following oesophagectomy—a systematic review

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Esophagectomy for esophageal carcinoma - surgical complications and treatment

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