Prospective study of routine contrast radiology after total gastrectomy

Lamb, PJ; Griffin, S. M.; Chandrashekar, MV; Richardson, D. L.; Karat, D; Hayes, Nick

doi:10.1002/bjs.4638

Cited by 62 publications

(51 citation statements)

References 76 publications

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“…11 However, more recent studies seem to suggest that swallows should only be performed on clinical concern because of the low sensitivity of this method for detecting leaks. [11][12][13] The evidence to support the use of routine contrast swallows is lacking and some studies have shown that swallows should only be requested in cases where an anastomotic leak is suspected clinically.…”

Section: Other Literaturementioning

confidence: 99%

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Tang

Humes

Gemmil

et al. 2013

annals

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INTRODUCTIONThe high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes. METHODS Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 -July 2009) and after (August 2009 -July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality. RESULTS There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (MannWhitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77

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Section: Other Literaturementioning

confidence: 99%

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Tang

Humes

Gemmil

et al. 2013

annals

View full text Add to dashboard Cite

show abstract

“…The leakage rate of esophagojejunostomy has ranged from 3 to 10% since the introduction of new devices for anastomosis [1,2,3]. Even recent studies have not reported a leakage rate of less than 1% for esophagojejunostomy [6, 7]. The lowest previously reported leakage rate was 1% among 588 patients treated at the National Cancer Institute in Japan [4] and 1.35% among 148 patients in Europe [8].…”

Section: Discussionmentioning

confidence: 96%

Minimum Leakage Rate (0.5%) of Stapled Esophagojejunostomy with Sacrifice of a Small Part of the Jejunum after Total Gastrectomy in 390 Consecutive Patients

Hyodo

Hosoya²,

Hirashima³

et al. 2007

Dig Surg

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Background: The development of new surgical instruments and devices has facilitated the performance of esophagojejunostomy after total gastrectomy. However, total prevention of dehiscence of anastomoses remains difficult. We introduced a new procedure for esophagojejunostomy using a circular stapler, requiring sacrifice of only a small part of the jejunum. Methods: The study group comprised 390 consecutive patients who underwent reconstruction by Roux-en-Y esophagojejunostomy, performed with a circular stapler, sacrificing a small part of the jejunum after total gastrectomy. We assessed anastomotic leakage and anastomotic stenosis after surgery. Results: Only 2 patients (0.5%) had leakage and 4 (1.0%) had anastomotic stenosis after reconstruction. All the patients were cured by conservative therapy. Conclusions: Esophagojejunostomy performed with a circular stapler after total gastrectomy, with sacrifice of only a small part of the jejunum, is a useful and easy procedure, with a leakage rate of 0.5%.

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“…Traditionally, many have deferred introducing oral intake until confirmation of a healed anastomosis by radiology despite data highlighting that routine contrast radiology does not influence rates of anastomotic leak. 9 Nutritional support is a key component of recovery after oesophageal and gastric surgery, and approaches should concentrate on both pre and postoperative phases.…”

Section: Discussionmentioning

confidence: 99%

Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

Gatenby

Shaw

Hine

et al. 2015

annals

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INTRODUCTION Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. METHODS An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. RESULTS In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. CONCLUSIONS The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity. KEYWORDSGastric neoplasms -Oesophageal neoplasms -Surgical procedures -Perioperative careEnhanced recovery Accepted 24 January 2015 CORRESPONDENCE TO Piers Gatenby, E: p.gatenby@ucl.ac.uk Enhanced recovery after surgery (ERAS) or fast track programmes have been well established in elective surgery for colorectal resections and joint replacement.1-6 These programmes benefit patients, healthcare providers and those commissioning healthcare by providing earlier recovery with faster return to normal activity as well as improvement in quality of care, productivity, consistency and patient experience with innovative and efficient multidisciplinary practice. 7 The aim of this study was to examine the approach to and outcomes of the implementation of an ERAS programme in a group of patients admitted for open oesophageal and gastric resections for adenocarcinoma under a single upper gastrointestinal surgeon at a tertiary referral centre. MethodsA retrospective audit was performed of the periods prior to (control group) and following (intervention group) the implementation of an ERAS pathway. The study was undertaken in a specialist cancer centre that serves a population of 1.6 million, receiving over 350 new oesophagogastric referrals, and performing approximately 75 oesophageal and gastric resections annually. All patients involved in the study were under the care of a single oesophagogastric surgeon (WHA). The control cohort consisted of all patients undergoing surgery between 1 January and 31 December 2009. The intervention was then implemented over a three-month period and the intervention cohort comprised all patients from 1 April 2010 to 31 March 2011. Demographic data on age and sex, and use of preoperative chemotherapy were recorded.Following the introduction of the intervention, all patients who were fit enough for surgery proceeded along the ERAS pathway as the default...

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Prospective study of routine contrast radiology after total gastrectomy

Abstract: There is no role for routine contrast swallow after total gastrectomy with a stapled oesophagojejunal anastomosis, but patients with clinical suspicion of leakage should undergo urgent contrast radiology, plus endoscopy if the contrast examination is normal.

Cited by 62 publications

References 76 publications

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Minimum Leakage Rate (0.5%) of Stapled Esophagojejunostomy with Sacrifice of a Small Part of the Jejunum after Total Gastrectomy in 390 Consecutive Patients

Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

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