Mortality and Morbidity after Resection for Adenocarcinoma of the Gastroesophageal Junction: Predictive Factors

Sauvanet, Alain; Mariette, C.; Thomas, Philippe; Lozac’h, P.; Ségol, P; Tiret, Emmanuel; Delpero, Jean‐Robert; Collet, Denis; Leborgne, J; Pradère, B.; Bourgeon, A; Triboulet, Jean–Pierre

doi:10.1016/j.jamcollsurg.2005.02.002

Cited by 226 publications

(157 citation statements)

References 32 publications

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“…The leakage healing rate was 85.7% and leakage-related mortality was 8.8% in this series, which is much lower than reported 21-35% in literatures (16)(17)(18), therefore, the managements for the leakages in our center were proven to be appropriate and effective. Even though leakage is dangerous and fatal, based on our experience, it is still possible to be prevented if some precautious measures are applied.…”

Section: Discussioncontrasting

confidence: 47%

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Ding

Mao

et al. 2017

J. Thorac. Dis.

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Background: It was reported in the literatures that the incidence of anastomotic leakage in patients with esophagogastric junction cancer decreased due to application of staplers and closure devices as well as gastric conduit technique in recent years, however, it increased slightly at our center since widely using the above devices and gastric conduit techniques from 2009. The objective of this study was to summarize our experiences in the management of anastomotic leakages and analyze the factors affecting leakage healing in the patients with esophagogastric junction cancer after surgical resection in recent 6 years. Methods: All patients who received surgical resections for esophagogastric junction cancer and diagnosed anastomotic leak at our center between January 2009 and December 2014 were retrospectively analyzed, we also enrolled the patients who had a longer hospital stay (>30 days) as they may develop anastomotic leak. The binary logistic regression in SPSS 16.0 was applied to analyze the factors that may affect leakage healing. Results: Of the 1,815 surgically treated esophagogastric junction cancer patients, 91 cases were diagnosed anastomotic leakage postoperatively. The patients were divided into two groups based on the median leakage healing time (40 days) in this series: fast healing group (37 cases) and slowly healing group (54 cases). All factors that may affect the leakage healing were put into analysis by using binary logistic regression. The results of the analysis showed that leakage size (OR =1.073, P=0.004), thoracic drainage (OR =12.937, P=0.037) and smoking index ≤400 (OR =1.001, P=0.04) significantly affected the healing time, while drinking history (P=0.177), duration of fever after anastomotic leak developed (P=0.084), and hypoproteinemia after leak (P=0.169) also apparently but not significantly affect the healing time.Conclusions: Though many factors may affect leakage healing in the esophagogastric junction carcinoma patients, leakage size, thoracic drainage and smoking index (≤400) are the most important factors affecting the leakage healing. Placement of a chest tube beside the anastomosis area during operation for early identification and control of an anastomotic leak to minimize contamination of the mediastinum is the most important way to promote leakage healing. A chest tube placing into the purulent cavities after the patients experienced leaks is also important for the cure of leakage. More attention should be paid perioperatively to the patients who had a smoking index (≥400) and the patients who suffered fever or hypoproteinemia.

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Section: Discussioncontrasting

confidence: 47%

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Ding

Mao

et al. 2017

J. Thorac. Dis.

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“…Several other studies have also investigated the role of adjuvant chemotherapy after curative resection, but most have failed to demonstrate any improvement in os or recurrence-free survival (rfs) in Western populations [7][8][9][10][11] , prompting the evaluation of neoadjuvant approaches for locally advanced gastric cancer. Moreover, according to the literature, complete resection (R0) is achieved only in approximately 70% of patients who undergo gastroesophageal cancer surgery 2,3,12,13 . Neoadjuvant chemotherapy with or without radiation therapy has therefore recently been added to the surgical protocol, with the aim of downstaging tumours and improving the rates of R0 resection and survival [14][15][16] .…”

Section: Resultsmentioning

confidence: 99%

Perioperative Chemotherapy for Gastroesophageal Cancer in British Columbia: A Multicentre Experience

2014

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“…however,difficulties to achieve complete resection and a sufficientsafety margin emerge, if thereisinfiltration of the distal esophagus up to 3cm. occasionally, transthoracic esophagectomya nd proximal gastric resection, also in patients with AEG type II tumors, areindicated (43,44). The goal of any approach with curative intent should be complete macroscopic and microscopic tumor resection and adequatel ymphadenectomy.The present study shows that in the vast majority of patients with AEG type II tumors, these can be achieved by the transabdominal approach with extended total gastrectomy and resection of the distal esophagus after wide splitting of the esophageal hiatuscombined with lymphadenectomy of the lower posterior mediastinum, in addition to d2 lymphadenectomy according to the principles in gastric cancer.…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the Esophago-Gastric Junction

2006

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Background: theborder between the esophagusand stomach givesrisetomany discrepancies in the current literature regarding the etiology,c lassification and surgical treatment of adenocarcinoma arisingatthe esophago-gastric junction. We have consequently used the AEG-criteria (adenocarcinoma of the esophago-gastric junction) forc lassification and have based the selection of the surgical approach on the anatomic topographic subclassification.Methods: in the following we reportananalysis of alarge and homogeneously classified population of 1602 consecutive patients with adenocarcinoma of the esophago-gastric junction, with an emphasis on the surgical approach, the pattern of lymphatic spread, the outcome after surgical treatment and the prognostic factors. demographic data, morphologic and histopathologic tumor characteristics, and long-term survival rates were compared among the three tumor subclassifiations.Results: The study confirmst he markedd ifferences in sex distribution, associated specializedintestinal metaplasia in theesophagus, tumor grading, tumor growth pattern, lymphatic spread, and stage between the three tumor entities. the degree of resection and lymph node status were the dominating independent prognostic factors by multivariate analysis. The data show no significantd ifferences of long-term survival after abdomino-thoracic esophagectomy and extended total gastrectomy in these patients.Conclusion: The classification of adenocarcinomas of the esophago-gastric junction in three types, AEG type I, type II and type III shows marked differencesbetween the tumor entities and is recommended for selection of aproper surgical approach. complete tumor resection and adequate lymphadenectomy are associated with good long-term prognosis. better surgical management and standardized procedures will improve the outcome also of patients who need to undergo more radical surgery,i.e. abdomino-thoracic esophagectomy.

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Mortality and Morbidity after Resection for Adenocarcinoma of the Gastroesophageal Junction: Predictive Factors

Cited by 226 publications

References 32 publications

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer

Perioperative Chemotherapy for Gastroesophageal Cancer in British Columbia: A Multicentre Experience

Adenocarcinoma of the Esophago-Gastric Junction

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