Successful Treatment of Esophagojejunal Disconnection after Total Gastrectomy by Insertion of a Covered Self-Expandable Esophageal Metallic Stent

Sampaio, José Artur; Waechter, Fábio Luiz; Pereira-Lima, Júlio Carlos; Fossati, Marco; Felicetti, José Carlos; Thiesen, Victor; Rostirolla, Renata Andreoli; Marques, Daniela Lemos; Hornos, Alexander Porley; Pereira-Lima, Luiz

doi:10.1067/s0016-5107(03)00030-0

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…A similar strategy has been proposed by Sarela et al after oesophagectomy for cancer; however, the borderline for surgical management of anastomotic leak was postoperative day 5 [ 19 ]. Another promising method of anastomotic failure management is endoscopic self-expandable metal stent placement [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor

Ciesielski

Kruszewski²,

Walczak

et al. 2017

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IntroductionSurgical resection is the only potentially curative modality for gastric cancer and it is associated with substantial morbidity and mortality.AimTo determine risk factors for postoperative morbidity and mortality following major surgery for gastric cancer.Material and methodsBetween 1.08.2006 and 30.11.2014 in the Department of Oncological Surgery of Gdynia Oncology Centre 162 patients underwent gastric resection for adenocarcinoma. All procedures were performed by 13 surgeons. Five of them performed at least two gastrectomies per year (n = 106). The remaining 56 resections were done by eight surgeons with annual volume lower than two. Perioperative mortality was defined as every in-hospital death and death within 30 days after surgery. Causes of perioperative deaths were the matter of in-depth analysis.ResultsOverall morbidity was 23.5%, including 4.3% rate of proximal anastomosis leak. Mortality rate was 4.3%. Morbidity and mortality were not dependent on: age, gender, body mass index, tumour location, extent of surgery, splenectomy performance, or pTNM stage. The rates of morbidity (50% vs. 21.3%) and mortality (16.7% vs. 3.3%) were significantly higher in cases of tumour infiltration to adjacent organs (pT4b). Perioperative morbidity and mortality were 37.5% and 8.9% for surgeons performing less than two gastrectomies per year and 16% and 0.9% for surgeons performing more than two resections annually. The differences were statistically significant (p = 0.002, p = 0.003).ConclusionsAnnual surgeon case load and adjacent organ infiltration (pT4b) were significant risk factors for morbidity and mortality following major surgery for gastric cancer. The most common complications leading to perioperative death were cardiac failure and proximal anastomosis leak.

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Section: Discussionmentioning

confidence: 99%

Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor

Ciesielski

Kruszewski²,

Walczak

et al. 2017

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“…If accidentally part of the implant is released into stomach, it should disintegrate quickly in the strongly acidic (pH ca 2) stomach content to avoid the necessity of urgent surgery. Although there are described non-degradable metal-based [10] or polymer based stents [11,12] for this application, a biodegradable stent would be certainly more advantageous. Hydrazone bond is known to be hydrolytically labile in acidic environment and relatively stable in neutral and basic environment.…”

Section: Introductionmentioning

confidence: 97%

Hydrazone-based hydrogel hydrolytically degradable in acidic environment

Vetrík

Přádný

Hrubý

et al. 2011

Polymer Degradation and Stability

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“…A nyelőcsőanastomosis-elégtelenség gyakorisága a nyaki anastomosisoknál 4-34%, az intrathoracalis szakaszon 5-17%, a distalis szakaszon 0,5-11% [1,2,[15][16][17][18][19]. A nyaki anastomosisok esetében nyálsipoly, perioesophagealis phlegmone, abscessus alakulhat ki.…”

Section: Megbeszélésunclassified

“…A súlyosabb phlegmonéval, abscessussal járó esetek műtéti kezelést igényelnek. Az intrathoracalis szakaszon kialakuló insufficientiák mediastinitist, mellüregi empyemát okozva magas mortalitást (50-70%) eredményeznek [1][2][3][15][16][17][18], általában reoperációt tesznek szükségessé. Az alsó harmadi és abdominalis nyelőcsőszakaszon ké-szült anastomosisok elégtelensége kapcsán peritonitis, abdominalis abscessus, ritkán oesophago/enterocutan sipolyok alakulhatnak ki, a mortalitás 25-30% a közlések szerint [1,2,4,16,[20][21][22][23].…”

Section: Megbeszélésunclassified

A szájüreg baktériumflórájának összefüggése az anastomosiselégtelenség következményeivel nyelőcső- és cardiatumoros betegeknél

Balázs

Winkler

Kristóf³

et al. 2017

Orvosi Hetilap

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Bevezetés: A tumor miatt végzett műtétek során készült nyelőcső-anastomosisok elégtelensége kapcsán az insufficientián át kilépő tartalom bakteriális összetételének a szövődmény kimenetelében jelentős befolyásoló szerepét tételez-hetjük fel. Célkitűzés: A vizsgálat célja az anastomosiselégtelenség következményeinek összevetése a betegek száj üregi bakteriális flórájával. Módszer: A prospektív vizsgálat során 131, műtétre került betegnél közvetlenül a műtét előtti órákban mintavételt végeztünk. A betegek szájüregi flórájának összetételét elemeztük. Az anastomosiselégtelenség következményei és a baktériumflóra összetétele közötti korrelációt vizsgáltuk. Eredmények: Patogén baktérium jelenléte a szájüregi flórában 50 esetben (38,2%) volt kimutatható. A szövődmény súlyossága és a patogén baktériumok előfordulási gyakorisága között a korrelációanalízis közepes erősségű kapcsolatot mutatott ki (r s = 0,553), az eredmény szignifikáns (p≤0,05). Következtetések: A patogén ágenseket tartalmazó flóra a varratelégtelenség eseteiben nagyobb kockázatot és súlyosabb kimenetelt eredményezhet, a meghatározó tényezők egyikeként értékelhető. A száj-üregi bakteriális flóra a műtéti előkészítés során a korábbiaknál nagyobb figyelmet és a műtéti előkészítés gyakorlatának megváltoztatását igényli. Orv. Hetil., 2017, 158(1), 25-30.Kulcsszavak: szájüregi baktériumflóra, nyelőcsőtumor, anastomosiselégtelenség, műtéti előkészítés Relationship of consequences of anastomotic insufficiency and bacterial flora of oral cavity in patients with esophageal and cardia cancerIntroduction: In the course of anastomotic insufficiency following resection of esophageal cancers the bacterial compound of the esophageal substance has a remarkable, presumable role in the outcome of complications. Aim: The purpose of this study is to compare the consequences of the anastomotic leak with the bacterial flora of patients' oral cavity. Method: In this prospective study a total of 131 patients were investigated directly before the surgical intervention taking a bacterial sample. Bacterial flora of patients' oral cavity was analysed; and the correlation between the consequences of the anastomotic leak and the content of the bacterial flora was examined. Results: Pathogenic bacteria in the oral microflora in 50 cases (38.2%) was found. Statistically significant, moderate correlation was found between the severity of the complication and the incidence of pathogenic bacteria (r s = 0.553; p≤0.05). Conclusions: Pathogenic agent in the microbial flora might induce higher risk and more severe outcome in case of anastomotic leakage and it might be evaluated as a determinative factor. Consideration of the bacterial flora of the oral cavity requires more attention in the preoperative preparation than before and it demands the change of the current practice.

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Successful Treatment of Esophagojejunal Disconnection after Total Gastrectomy by Insertion of a Covered Self-Expandable Esophageal Metallic Stent

Cited by 6 publications

References 22 publications

Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor

Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor

Hydrazone-based hydrogel hydrolytically degradable in acidic environment

A szájüreg baktériumflórájának összefüggése az anastomosiselégtelenség következményeivel nyelőcső- és cardiatumoros betegeknél

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