Wide Gastric Conduit Increases the Risk of Benign Anastomotic Stricture After Esophagectomy

Abstract

Background To identify the association between the width of the gastric conduit and the benign anastomotic stricture (BAS) after esophagectomy with end-to-side cervical anastomosis for esophageal cancer. Methods Patients with esophageal cancer who underwent esophagectomy between July 2013 and July 2014 were included in this study. The gastric conduit was used for reconstruction in all patients and end-to-side cervical anastomosis were performed using a circular stapler. The patients were divided into a narrow group (3-5 cm) and a wide group (>5 cm) based on the gastric conduit width. Univariate and multivariate logistic regressions were used to analyze the possible factors (patients’ age, gender, preoperative comorbidities, neoadjuvant chemotherapy, gastric conduit width, anastomotic leakage) that could affect the incidence of BAS. Results Two-hundred and one patients were included in this study. The median follow-up period was 29 months (17-58 months). Seven cases (3.5%) showed anastomotic leakage in the postoperative period and 38 patients (18.9%) developed BAS; all within the first year of follow-up. In univariate analysis, the width of the gastric conduit was the only risk factor for the development of BAS (odds ratio [OR] = 3.36, P = .005). In multivariate logistic regression analysis, the wide group was an independent significant risk factor for the development of BAS developing compared with the narrow group (OR = 2.84, P = .02). Conclusions A wide gastric conduit width (>5 cm) is an independent risk factor for the development of BAS after esophagectomy and stapled cervical end-to-side anastomosis for esophageal cancer.

Influence of Neoadjuvant Chemotherapy on Anastomotic Complications and Long-Term Prognosis after Laparoscopic Radical Gastric Cancer Surgery

“…Zhu. et al through univariate and multivariate analysis, neoadjuvant chemotherapy is not an independent risk factor for anastomotic stenosis [15]. This is the same as the results of this study.…”

“…Anastomotic stenosis is mostly caused by postoperative anastomotic tissue edema and inflammation leading to tissue hyperplasia or scar contracture, which eventually leads to gastrointestinal obstruction, nutritional disorders, and then affects the patient's postoperative recovery. At present, it is believed that the main reason for the anastomotic stenosis is the width of the gastric tube after the operation and the way the anastomosis is sutured [15,16]. There is no clear conclusion about the impact of neoadjuvant on anastomotic stenosis.…”

Association of Conduit Dimensions with Perioperative Outcomes and Long-Term Quality of Life after Esophagectomy for Malignancy

“…In general, creating a tubular gastric conduit with a diameter of less than 5 cm has been advised. 10 , 18 , 21 Rates of anastomotic leak and reflux esophagitis are lower in a reconstructed gastric conduit with a narrower diameter of 4 to 6 cm than in a gastric conduit where the entire stomach is used. 18 Likewise, having a gastric conduit with a diameter less than 4 cm is associated with a decreased risk of developing anastomotic strictures after esophagectomy compared with having a gastric conduit with a diameter greater than 5 cm.…”

“… 18 Likewise, having a gastric conduit with a diameter less than 4 cm is associated with a decreased risk of developing anastomotic strictures after esophagectomy compared with having a gastric conduit with a diameter greater than 5 cm. 21 To the best of our knowledge, no quantitative data exist on the association between the width of the conduit and the long-term quality of life. We hypothesized that the maximum intrathoracic conduit width shown on the first postoperative CT scan would help predict the long-term consequences of delayed gastric emptying and reflux.…”

A nyelőcsőpótlás szövődményei

“…Az anastomosisszűkület okai között szerepelhet a technikai hibán túl ischaemia [14], epés vagy savas reflux, valamint megtöretés, például substernalis vagy antethoracalis pótlás esetén. Zhu és mtsai [17] kimutatták, hogy 5 cm-nél szélesebb gyomorcső esetén vagy teljes gyomor használatakor az anastomosisszűkület szignifikánsan gyakoribb. Számíthat a kiválasztott körkörös varrógép átmérője, és szerepet játszhat technikai hiba.…”