The Risk Factors for Refractory Fistula after Esophagectomy with Gastric Tube Reconstruction in Patients with Esophageal Cancer

Abstract

Background/Aims: Anastomotic leakage (AL) after esophagectomy is associated with high rates of postoperative morbidity and mortality. In cases with leakage, a refractory fistula (RF) is sometimes recognized after esophagectomy. The aim of this study was to evaluate the risk factors for RF after esophagectomy with gastric tube reconstruction. Methods: This study enrolled 244 consecutive esophageal cancer patients who had undergone esophagectomy with gastric tube reconstruction. RF was defined as a noncurative anastomotic site-cutaneous fistula that had been present for more than 2 months. We evaluated the risk factors for RF. Results: AL occurred in 30 patients (12.3%). There was one mortality case (0.4%) due to mediastinitis caused by AL in the present series. A multivariate analysis revealed that the subcutaneous route was an independent risk factor for AL (OR 4.42, 95% CI 1.42-13.8, p = 0.01), and that the subcutaneous route was an independent risk factor for RF (OR 13.30, 95% CI 2.50-71.30, p = 0.0024). Conclusion: The results of this retrospective study suggest that subcutaneous route was associated with an increased risk of RF after esophagectomy with gastric tube reconstruction. The preoperative identification of risk factors may contribute to the prevention of postoperative AL and RF.

Endoscopic filling with polyglycolic acid sheets and fibrin glue of persistent fistula after esophagectomy

“…In addition, clinical outcomes in the present series seemed very satisfactory, in that persistent post-esophagectomy fistula, refractory to conservative treatment, resolved within a relatively short period in 10 patients. Yamana et al reported that the mean period from first operation to resumption of oral intake in patients with persistent fistula after esophagectomy was 151.3 days, in stark contrast to the 65.3 days in the present series [10]. The mean periods from the first and final application of the PGAfibrin method to the resumption of oral intake were 31.6 and 14.7 days, respectively, notably shorter times compared to previous reports.…”

“…In addition, clinical outcomes in the present series seemed very satisfactory, in that 10 patients with the PFACTAL after esophagectomy achieved cure within a relatively short period. Yamana et al reported that the mean period from first operation to resumption of oral intake in patients with the PFACTAL after esophagectomy was 151.3 days, in stark contrast to the 65.3 days in the present series [10].…”

A new technology for reducing anastomotic fistula in the neck after esophageal cancer surgery

“…Anastomotic stenosis and fistula are the most common postoperative complications of esophageal cancer (18). These two complications not only lead to a low quality of life of patients but also endanger their lives (19). Therefore, it is extremely important to reduce the risk factors of anastomotic stenosis and fistula, and it is particularly urgent to find new embedding materials.…”

Do We Need to Add Postoperative Radiotherapy in Patients Undergoing Trimodality Therapy for Esophageal Squamous Cell Carcinoma with Positive Lymph Nodes Disease?

“…Lv et al [17] mentioned that there were no significant differences in survival between the preoperative chemoradiotherapy and postoperative chemoradiotherapy arm (p > 0.05). However, the postoperative therapy also provides several benefits including decision based on true pathologic stage, more accurate assessment of disease extent to allow for delineation of disease involvement, and less concern about increase in perioperative morbidity and mortality after preoperative induction [4,5,18]. Although CCRT is an important component of therapy, when used alone, it results in unacceptably high rates of relapse and poor long-term survival rates in LN-positive patients.…”