Cervical Esophagogastric Anastomosis Fistula Following Esophagectomy: A Problem With No Solution?

Takeda, Flávio Roberto; Sallum, Rubens Antônio Aissar; Cecconello, Ivan; Nahas, Sérgio Carlos

doi:10.1590/0102-672020210002e1619

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…In all cases, an anastomosis was performed in the cervical region, which is associated to postoperative fistula due to tension of the esophagogastric anastomosis and ischemia of the proximal part of the gastric tube. However, the management of this type of fistula is simpler than a fistula from mediastinal anastomosis, often being treated conservatively with local drainage, antibiotics, and appropriated diet until resolution, without the need for reapproach or use of endoscopic stents 20 . In our study, reoperation was indicated in nine cases (13%), a rate lower than that of the fistula (22 patients, 33%), corroborating the possibility of conservative treatment in most patients.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Outcomes of the Esophagectomy Minimally Invasive in Esophageal Cancer

Francischetto,

Pinheiro,

Viana

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: The incidence of esophageal cancer is high in some regions and the surgical treatment requires reference centers, with high volume, to make surgery feasible. AIMS: To evaluate patients undergoing minimally invasive esophagectomy by thoracoscopy in prone position for the treatment of esophageal cancer and to recognize the experience acquired over time in our service after the introduction of this technique. METHODS: From January 2012 to August 2021, all patients who underwent the minimally invasive esophagectomy for esophageal cancer were retrospectively analyzed. In order to assess the factors associated with the predefined outcomes as fistula, pneumonia, and intrahospital death, we performed univariate and multivariate logistic regression analyses, accounting for age as an important factor. RESULTS: Sixty-six patients were studied, with mean age of 59.5 years. The main histological type was squamous cell carcinoma (81.8%). The incidence of postoperative pneumonia and fistula was 38% and 33.3%, respectively. Eight patients died during this period. The patient's age, T and N stages, the year the procedure was performed, and postoperative pneumonia development were factors that influenced postoperative death. There was a 24% reduction in the chance of mortality each year, associated with the learning curve of our service. CONCLUSIONS: The present study presented the importance of the team's experience and the concentration of the treatment of patients with esophageal cancer in reference centers, allowing to significantly improve the postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Early Postoperative Outcomes of the Esophagectomy Minimally Invasive in Esophageal Cancer

Francischetto,

Pinheiro,

Viana

et al. 2023

ABCD, arq. bras. cir. dig.

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“…Esophagectomy by videothoracoscopy is a minimally invasive technique and the treatment of choice for many illnesses, from malignant and benign diseases, with low morbidity and mortality, and is a very safe method when performed by experienced surgeons 8 . There were no records found in the literature on esophagoceles treated with videothoracoscopy after caustic ingestion.…”

Section: Discussionmentioning

confidence: 99%

Esophagocele Due to Two Times Caustic Ingestions: Resection Through Videothoracoscopy

Alves

Tercioti

Neto

et al. 2022

ABCD, arq. bras. cir. dig.

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BACKGROUND: Caustic ingestion is still a health problem of utmost importance in the West. In developing countries, this incident remains at increase and it is associated with unfavorable factors like social, economic, and educational handicaps, besides a lack of prevention. Esophagocele is a rare consequence of caustic ingestion. AIM: We aimed to describe a patient with multiple caustic ingestions who presented an esophagocele resected by videothoracoscopy. METHODS: A woman ingested caustic soda when she was only 17 years old in a suicidal attempt during a depressive crisis. Initially, she was submitted to a retrosternal esophagocoloplasty with the maintenance of her damaged esophagus. After 1 year of this first surgery, she ingested caustic soda again in a new suicidal attempt. Her transposed large bowel in the first surgery became narrow, being replaced in a second surgery by a retrosternal esophagogastroplasty. Still, at the second surgery, her damaged esophagus remained in its original position in the posterior mediastinum. However, after 5 years, she developed an esophagocele. RESULTS: The esophagocele was resected through videothoracoscopy in a prone position, employing four trocars. The postoperative was uneventful. CONCLUSION: Esophageal exclusion must always be recorded because esophagocele presents unspecific symptoms. The videothoracoscopy in a prone position is an excellent technical option to resect esophagoceles.

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“…Most of the available devices have been improved, but they are subject to many biases, such as intraoperative interference, medications, clinical conditions, and comorbidities. 4 , 5 (4) The interference of perioperative treatment, such as chemotherapy and radiotherapy, in tissue healing is under debate, which could be a factor that interferes even more in the results. 4 To conclude, we really appreciate all comments regarding our previous study, and hopefully we will move on to a randomized controlled trial very soon.…”

mentioning

confidence: 99%

Cervical Esophagogastric Anastomosis Fistula Following Esophagectomy: A Problem With No Solution?

Cited by 3 publications

References 9 publications

Early Postoperative Outcomes of the Esophagectomy Minimally Invasive in Esophageal Cancer

Early Postoperative Outcomes of the Esophagectomy Minimally Invasive in Esophageal Cancer

Esophagocele Due to Two Times Caustic Ingestions: Resection Through Videothoracoscopy

Reply from authors: Leakage of cervical anastomosis after esophagectomy: Insights of local tissue perfusion

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