Novel esophageal stent for treatment of cervical anastomotic leakage after esophagectomy

Wu, Gang; Yin, Meipan; Zhao, Yan; Fang, Yi; Zhao, Jia; Han, Xinwei

doi:10.1007/s00464-017-5545-6

Cited by 9 publications

(15 citation statements)

References 13 publications

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“…After removing 2,382 duplicates, 2,733 titles and abstracts were screened, and 126 articles underwent full-text assessment, of which 32 were included in the systematic review (Fig. 1) [21‒52]. We also checked the reference list of previous systematic reviews on the topic but found no further relevant studies.…”

Section: Resultsmentioning

confidence: 99%

Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management

Azevedo¹,

Ortigão²,

Pimentel‐Nunes³

et al. 2023

GE Port J Gastroenterol

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Introduction: With the increase of esophageal and gastric cancer, surgery will be more often performed. Anastomotic leakage (AL) is one of the most feared postoperative complications of gastroesophageal surgery. It can be managed by conservative, endoscopic (such as endoscopic vacuum therapy and stenting), or surgical methods, but optimal treatment remains controversial. The aim of our meta-analysis was to compare (a) endoscopic and surgical interventions and (b) different endoscopic treatments for AL following gastroesophageal cancer surgery. Methods: Systematic review and meta-analysis, with search in three online databases for studies evaluating surgical and endoscopic treatments for AL following gastroesophageal cancer surgery. Results: A total of 32 studies comprising 1,080 patients were included. Compared with surgical intervention, endoscopic treatment presented similar clinical success, hospital length of stay, and intensive care unit length of stay, but lower in-hospital mortality (6.4% [95% CI: 3.8–9.6%] vs. 35.8% [95% CI: 23.9–48.5%]. Endoscopic vacuum therapy was associated with a lower rate of complications (OR 0.348 [95% CI: 0.127–0.954]), shorter ICU length of stay (mean difference −14.77 days [95% CI: −26.57 to −2.98]), and time until AL resolution (17.6 days [95% CI: 14.1–21.2] vs. 39.4 days [95% CI: 27.0–51.8]) when compared with stenting, but there were no significant differences in terms of clinical success, mortality, reinterventions, or hospital length of stay. Conclusions: Endoscopic treatment, in particular endoscopic vacuum therapy, seems safer and more effective when compared with surgery. However, more robust comparative studies are needed, especially for clarifying which is the best treatment in specific situations (according to patient and leak characteristics).

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Section: Resultsmentioning

confidence: 99%

Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management

Azevedo¹,

Ortigão²,

Pimentel‐Nunes³

et al. 2023

GE Port J Gastroenterol

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“… 26 , 27 , 28 However, traditional esophageal stents are indicated for the thoracic AFs rather than the cervical AFs because of the potential patient intolerance or stent migration as the residual esophagus is too short for the placement of the stents, and the stent migration inevitably leads to the failure to stop the leakage. 18 Custom-designed stents have been developed and reported to be effective for cervical anastomotic fistula, however, the study sample size is quite small, and this novel stent is unavailable commercially. 18 In our study series, covered stent was attempted and failed in only 1 patient (pt.…”

Section: Discussionmentioning

confidence: 99%

“… 18 Custom-designed stents have been developed and reported to be effective for cervical anastomotic fistula, however, the study sample size is quite small, and this novel stent is unavailable commercially. 18 In our study series, covered stent was attempted and failed in only 1 patient (pt. no.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the covered stent insertion into the cervical esophagus often causes strong pharyngeal discomfort or stent migration, which ultimately results in treatment failure. 17 Although custom-designed stents have been successfully employed in the treatment of cervical anastomotic leakage after esophagectomy, 18 their effectiveness requires more studies for confirmation, and such custom-designed stents are not commercially available. Simple primary closure is often associated with leakage relapses due to poor local tissue vitality and infection.…”

Section: Introductionmentioning

confidence: 99%

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Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap

Deng

et al. 2022

Brazilian Journal of Otorhinolaryngology

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“…However, in our series, leaks after TTE were managed with a covered stent (7/10), while early post-operative leaks were treated with reoperation. Leaks after THE were treated conservatively (7/11) with the controlled fistula technique, opening of the cervical wound and packing and daily dressing rather than with a stent because of the unavailability of a conventional stent at the cervical location [30].…”

Section: Discussionmentioning

confidence: 99%

Trans-thoracic versus trans-hiatal resection for oesophageal carcinoma: a retrospective comparative study of a single-centre case series

Baram

Sherzad²

2020

Cardiothorac Surg

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Background Oesophageal carcinoma (EC) is the eighth most common cancer. Surgery is the cornerstone of management for resectable EC. Trans-thoracic oesophagectomy (TTE) and trans-hiatal oesophagectomy (THE) are the two most widely practised procedures. Most of the related controversies are centred on both early and late post-operative complications and mortality (in terms of overall survival and cancer-free survival). This was a single-centre, retrospective, comparative study analysing the outcomes of two EC resection methods. All 87 patients underwent surgery by the same surgical team over 13 years. Consequently, 87 oesophagectomies with curative intent were performed and divided into the TTE group (group A = 47) and the THE group (group B = 40). Results The mean patient age was 65.60 ± 6.30 years in the TTE group and 63.48 ± 9.34 years in the THE group. No significant difference was found in operative time, blood loss or duration of stay in the intensive care unit. The duration of hospital stay was significantly different between the THE and TTE groups (17.25 ± 5.92 vs. 12.93 ± 3.44, respectively; P ≤ 0.001). In-hospital mortality was higher in the TTE group (9/47, 19.14%) than in the THE group (5/40, 12.5%) (P = 0.400). The mean survival rate from our series showed the superiority of group A (TTE) (65.56 months) over group B (THE) (45.01 months), with P = 0.146. Conclusion No high level of evidence suggests the superiority of one surgical procedure over another. The THE procedure is less time-consuming concerning care and follow-up, and most patients were more satisfied and experienced less pain than with the TTE procedure. Both THE and TTE have comparable post-operative anastomotic complications, and they have no significant long-term survival differences.

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Novel esophageal stent for treatment of cervical anastomotic leakage after esophagectomy

Abstract: Placement of the novel esophageal covered stent is a minimally invasive, efficacious treatment option for the patients with cervical anastomotic leakage after esophagectomy.

Cited by 9 publications

References 13 publications

Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management

Anastomotic Leakages after Surgery for Gastroesophageal Cancer: A Systematic Review and Meta-Analysis on Endoscopic versus Surgical Management

Management of refractory cervical anastomotic fistula after esophagectomy using the pectoralis major myocutaneous flap

Trans-thoracic versus trans-hiatal resection for oesophageal carcinoma: a retrospective comparative study of a single-centre case series

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