Risk Factors for Development of Benign Cervical Strictures After Esophagectomy

Abstract

The benign cervical stricture rate after esophagectomy was relatively high. Cardiovascular disease, gastric tube compared with colonic interposition and postoperative anastomotic leakage were independent predictors for development of benign anastomotic stricture. Anastomotic leakage, chemoradiotherapy and early development of stricture were independently associated with the development of refractory strictures, requiring a higher number of dilations. Prevention of anastomotic stricture formation should be focused on prevention of anastomotic leakage.

Cervical esophagogastric anastomosis with invagination after esophagectomy

“…In the present study, 13 (24%) cases developed postoperative strictures of anastomosis; this rate lies within the five to 45% limit described by other authors 9,10 . We believe this result could have been due to the fact that anastomosis with invagination did not influence the factors that might predispose the formation of fistula, such as ischemia in the proximal portion to the gastroplasty.…”

“…In addition to fistula, other factors, such as cardiac insufficiency, ischemia of the gastric fundus, and mechanical anastomosis can contribute to the development of stenosis 9,10 .…”

Minimally Invasive Oesophagectomy: Preliminary Results after Introduction of an Intrathoracic Anastomosis

“…In a prospective series of 607 patients with a cervical anastomosis, the incidence of anastomotic stenosis and dilatation for benign strictures was 41.7% [13], which is in accordance with other publications reporting an incidence of 26-42% [8,9,10,11]. Although the present study is not comparative, the incidence of stricture formation and dilatation after an intrathoracic anastomosis seems significantly lower than that reported after a cervical anastomosis.…”

“…Benign stricture formation and recurrent laryngeal nerve trauma are common complications after oesophagectomy and cervical anastomosis, with an incidence of 26-42% [7,8,9,10,11] and around 20%, respectively [12,13,14,15]. These complications are major causes of functional morbidity causing dysphagia and hoarseness.…”

“…These complications are major causes of functional morbidity causing dysphagia and hoarseness. In order to reduce dysphagia to an acceptable level, multiple dilatations are often required for patients with benign strictures of the anastomosis [11]. Moreover, recurrent laryngeal nerve palsy increases post-operative ventilation time and intensive care unit (ICU) and hospital length of stay [13].…”