Risk factors for benign anastomotic stricture post-oesophagectomy: single-centre analysis of 702 oesophagectomies with squamous cell carcinoma

Abstract

Background Benign stricture formation after oesophagectomy makes a considerable impact on postoperative recovery, nutritional status and quality of life. Our aim was to investigate the incidence and risk factors for benign anastomotic stenosis post-oesophagectomy in a large series of patients. Methods We conducted a retrospective study of all patients undergoing oesophagectomy of oesophageal squamous cell carcinoma (ESCC) in our department from August 2012 to May 2013. Anastomotic stricture was identified clinically and radiologically. A total of 14 clinicopathological variables were assessed by univariate and multivariate logistic regression analyses. Results The study included 702 patients, and anastomotic stricture occurred in 62 patients (8.8%), which was significantly higher after cervical (20.8%) anastomosis than below (7.4%) or above (6.6%) aortic arch anastomosis. The anastomotic stricture rate was 31.8% in single-layer hand sewn (s-HS) anastomosis, 11.7% in circular stapled (CS) anastomosis, 10.4% in double-layer hand-sewn (d-HS) anastomosis and 1.9% in semi-mechanical (SM) anastomosis. The univariate analysis found that hypertension, surgical approach, anastomotic technique, anastomosis site, total number of removed lymph node and anastomotic leakage were associated with anastomotic stricture rate (P<0.05). Age, gender, body mass index (BMI), history of smoking or diabetes, the length of tumour, pT stage, pN stage and historical grading showed no statistically significant difference in the incidence of benign stenosis (P>0.05). On multivariate analysis, anastomosis site (P=0.006) and anastomotic technique (P<0.001) were independently associated with stricture risk. Conclusions Our study highlighted that patients with ESCC undergoing cervical anastomosis should be cautiously monitored postoperatively as a result of relative high stricture rate. SM technique is the preferred method of oesophago-gastric anastomosis due to a decreased stricture formation compared with other techniques.

Background Factors Associated with Postoperative Complications in Patients with Advanced Hypopharyngeal Cancers Undergoing Total Pharyngolaryngoesophagectomy Followed by Free Jejunal Flap Reconstruction

“…No previous reports have documented the associations between post-TPLE complications and stage; however, an association between the total number of lymph nodes removed intraoperatively and postoperative anastomotic stricture was reported in patients who underwent esophagectomy for esophageal cancer. 14 The most frequent complication in our cohort was esophagojejunal anastomotic stricture, which occurred in nine cases (39%), including all severity grades. This incidence rate is similar to that reported previously.…”

“…Necrosis of the free jejunal graft is the most serious complication of TPLE/free jejunal reconstruction. The incidence rates of free jejunal flap necrosis were approximately 1 to 5%, 8,14,17 and free jejunal flap reconstruction is a reconstructive procedure that results in the highest graft survival rates in the head and neck region. In the present study, we showed that jejunal flaps survived in all of the 23 cases, which resulted in a satisfactory surgical outcome.…”

“…No previous reports have documented the associations between post-TPLE complications and stage; however, an association between the total number of lymph nodes removed intraoperatively and postoperative anastomotic stricture was reported in patients who underwent esophagectomy for esophageal cancer. 14…”