Subtotal stomach in esophageal reconstruction surgery achieves an anastomotic leakage rate of less than 1%

Abstract

Aim The objective of this retrospective, single‐institution study was to assess the safety and feasibility of reconstruction using subtotal stomach (SS) with esophagectomy for patients with esophageal cancer (EC). Although several different gastric‐tube‐making and anastomotic methods have been reported, the incidence rate of anastomotic leakage with EC surgery is generally reported over 10%. Complications should be avoided, and patient quality of life (QOL) should be maintained postoperatively. We have used SS reconstruction and hand‐sutured cervical esophagus‐subtotal gastric anastomosis at the neck wound in EC surgery. Short‐ and long‐term outcomes in cases using SS are not well known. Methods Between January 2008 and September 2019, 300 patients underwent esophagectomy for EC and reconstruction using SS. The primary endpoint was the rate of anastomotic leakage. Secondary endpoints were postoperative morbidities, QOL, and changes in patients’ body weight and skeletal muscle weight. Results Anastomotic leakage was observed in two patients (0.67%), and pneumonia was observed in nine patients (3.0%). Fifteen patients (5.0%) had an anastomotic stenosis requiring a bougie. Nausea occurred in 11 patients (3.7%), and dumping syndrome occurred in seven patients (2.3%). Dysphagia and early feeling of abdominal fullness scores tended to be high after surgery but gradually decreased after 6 months. Good results were obtained for reflux feeling scores. Body weight changed with an average decrease of −2 ± 3.71 kg ( P = .071) over 5 years. Conclusion Reconstruction using SS resulted in an extremely low rate of anastomotic leakage and good QOL postoperatively in patients with EC.

Risk Factors of Benign Stricture of Anastomotic Stoma after Esophagectomy and Therapeutic Effect of Stent Implantation

“…Inclusion criteria were as follows: ① All patients who met the diagnostic criteria for esophageal cancer and underwent surgical treatment [ 7 ]. The stenosis group also needed to meet the diagnostic criteria of benign stenosis of the anastomosis, the specific criteria are as follows: grade IV: severe stenosis, cannot be expanded, and needs to be relieved by surgery; grade III: three or more consecutive dilations are required and repeated esophageal strictures; grade II: dilation ≤2 times, anastomotic diameter <1 cm, and eating semiliquid disorder; grade I: slight obstruction to eating, no need for expansion; and grade 0: there is no stricture of the anastomotic stoma, and there is no obstruction to eating [ 8 ].…”

Subtotal esophagectomy followed by subtotal gastric reconstruction for Boerhaave's syndrome: Case report with literature review

“…This procedure should be undertaken only by surgeons who are confident in performing the two-step reconstruction. Because the rate of anastomotic leakage in subtotal gastric reconstruction performed during esophageal cancer surgery is as low as 0.5%, we could select esophageal removal and 2-step reconstruction without hesitation [22] . This surgical procedure has also been reported to result in good postoperative quality of life.…”

The Role of Adjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma Patients with Pathological Positive Lymph Nodes After Neoadjuvant Chemotherapy Followed by Esophagectomy: a Single Institute Retrospective Analysis

“…There were few adverse events (grade ≥ 3) following adjuvant chemotherapy. Since we routinely perform enteral nutrition using a jejunostomy tube for 6 months after surgery [ 15 ], we believe that even patients who have completed NAC and surgery could safely receive postoperative adjuvant chemotherapy.…”

“…However, if the intraoperative rapid histopathological diagnosis of the lymph nodes around the recurrent laryngeal nerves indicated metastasis, three-field dissection was performed. We usually perform reconstruction using the subtotal stomach through the posterior mediastinal route [ 15 ]. However, the retrosternal route was selected when radiotherapy to the posterior mediastinum was considered because of locally advanced cancer.…”