Incidence and Risk Factors of Symptomatic Hiatal Hernia Following Resection for Gastric and Esophageal Cancer

Abstract

HH is a major adverse event after resection for gastric or esophageal cancer especially among patients undergoing extended gastrectomy for cardia cancer requiring a high rate of repeat surgery. Therefore, intensive follow-up examinations for high-risk patients and early diagnosis of asymptomatic patients are essential for selecting patients for elective surgery to avoid unpredictable emergent events with high morbidity and mortality.

Identification of crucial miRNAs and genes in esophageal squamous cell carcinoma by miRNA-mRNA integrated analysis

“…[2,3] Epidemiological evidence suggests a different risk factor profile including cigarette smoking, alcohol consumption, highly salted meats, and so on. [4,5] If earlier detection and aggressive medical and surgical treatment of EC could be achieved, then the five-year survival rates would exceed 80%. [6,7] Unfortunately, because effective early diagnosis for EC remains elusive, EC often presents in an insidious and nonspecific manner, and the one-year survival rate remains lower than 15%.…”

Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

“…Minimally-invasive esophago-gastric index surgery as a risk factor for trans-hiatal herniation due to decreased formation of abdominal adhesions, which has been repeatedly reported in the literature [ 11 , 17 , 19 , 28 , 30 , 32 , 33 ], seems to be underrepresented in the patient cohort of the present study. This might be due to the fact that the institutional standard for gastrectomy and trans-hiatal esophagectomy (with gastrectomy) was conventional open surgery and abdomino-thoracic esophagectomy was approached hybrid minimal-invasively in approximately one third of the patients in the past as published previously [ 5 ].…”

“…Nevertheless, minimally invasive surgery, especially for trans-hiatal and Ivor Lewis esophagectomy as well as structured surveillance with cross-sectional imaging are both increasingly provided to patients with esophago-gastric cancer. Furthermore, long-term survival is improved in upper gastrointestinal cancer patients due to better multimodal treatment strategies, thus trans-hiatal herniation after oncologic esophago-gastric surgery will become increasingly relevant in the future (note the rising number of reports in the more recent literature, Table 5 ) [ 11 , 17 , 19 , 28 , 30 , 32 ]. However, evidences derived from the current literature or recommendations from medical societies clearing the questions on “how to approach the hiatus during esophago-gastric surgery “ and “when, why and how” to repair trans-hiatal herniation after esophagectomy or gastrectomy are not yet defined.…”

“…The most frequently prolapsed organ is transverse colon into the left chest (literature review in Table 5 ). Therefore, some risk factors for trans-hiatal hernia development after esophagectomy or gastrectomy can be found in the present patient cohort, including pre-existing hiatal hernia (which were present in three of five patients from the gastrectomy group), iatrogenic enlargement of the hiatus and diaphragmatic crus incision—especially of the left one, without resection, violence to the left pleura and higher tumor stages, especially of carcinoma of the esophago-gastric junction making crus resection necessary [ 7 , 10 , 11 , 13 – 19 , 21 – 23 , 28 – 32 , 34 – 37 ]. These lead consecutively to a loss of functional anatomy of the hiatus.…”

“…These lead consecutively to a loss of functional anatomy of the hiatus. Additionally, a lower BMI (< 25 kg/m 2 ) or excessive weight loss after index surgery facilitates the mobility of intra-abdominal viscera and diabetes as well as neoadjuvant therapy impair wound healing [ 10 , 11 , 14 , 17 , 22 , 30 , 32 , 36 ]. However, several measures have been described in the literature to restore hiatal function during index surgery in the hope to reduce the incidence of HH after esophago-gastric surgery, but data on their efficacy are still lacking: direct closure of the diaphragmatic defect anteriorly (because the conduit lies posteriorly) and/or posteriorly, fixation of the conduit to the crura, mesh interposition, colopexy or omentopexy in front of the hiatus [ 9 – 11 , 13 , 15 – 19 , 34 , 37 , 38 ].…”