A Study on Anastomotic Complications after Esophagectomy for Cancer of the Esophagus: A Comparison of Neck and Chest Anastomosis.
- Author:
Hyoung Ryel LEE
1
;
Jin Hee KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Pusan National University. hrlee@hyowon.pusan.ac.kr
- Publication Type:Original Article
- Keywords:
Esophageal neoplasm;
Anastomosis, surgical;
Postoperative complications
- MeSH:
Anastomosis, Surgical;
Anastomotic Leak;
Cardia;
Constriction, Pathologic;
Esophageal Neoplasms*;
Esophagectomy*;
Esophagus;
Humans;
Mortality;
Neck*;
Postoperative Complications;
Prevalence;
Recurrence;
Risk Factors;
Thorax*
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1999;32(9):799-805
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Leakage, stricture formation, and tumor recurrence at the anastomotic site are serious problems after esophagectomy for cancer of the esophagus or cardia. The prevalence of these postoperative complications may be affected by whether an anastomosis is made in the neck or in the chest, therefore a comparison was made between anastomoses made at these two sites. MATERIAL AND METHOD: Between 1987 and 1998, 36 patients with cancer of the esophagus underwent transthoracic esophagectomy with cervical(NA, n=20) or thoracic anastomosis(CA, n=16). The tumors were staged postoperatively(stage IIA, n=13; s tage IIB, n=7; stage III, n=16) and were located in the middle thoracic(n=22) or lower thoracic esophagus and cardia(n=14). RESULT: The overall operative mortality was 8.3%(5% for NA group, 12.5% for CA group). The anastomotic leak rate for the NA group was 15.0% and 12.5% for the CA group. The anastomotic leak rate differed according to the manual(27.3%) or stapled(8.0%) techniques(p < 0.05). The median proximal resection margins in the NA and CA groups were 9.6 cm and 5.8 cm, and the corresponding rates of anastomotic tumor recurrence were 5.3% and 28.6%(p < 0.05). The prevalence of benign stricture formation (defined as moderate/severe dysphagia) was higher in the NA group(36.8%) than in the CA group(21.4%). When an anastomosis was made by the stapled technique, smaller size of the staple increased the prevalence of stricture formation - 41.7% with 25-mm staple and 9.1% with 28-mm staple(p < 0.05). CONCLUSION: Wider resection margin could decrease the anastomotic tumor recurrence, and the stapled technique could decrease the anastomotic leak. The prevalence of benign stricture was higher in the cervical anastomosis but the anastomotic leak and smaller size(25-mm) of the staple should be considered as risk factors.
