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01-02-2015 | Original Scientific Report

Impact of the Route of Reconstruction on Post-operative Morbidity and Malnutrition after Esophagectomy: A Multicenter Cohort Study

Authors: Makoto Yamasaki, Hiroshi Miyata, Takushi Yasuda, Osamu Shiraishi, Tsuyoshi Takahashi, Masaaki Motoori, Masahiko Yano, Hitoshi Shiozaki, Masaki Mori, Yuichiro Doki

Published in: World Journal of Surgery | Issue 2/2015

Abstract

Background

Reconstruction after esophagectomy is mainly performed through the retrosternum (RS) or posterior mediastinum (PM). However, the best approach is not clear. This study aimed to assess the impact of the route of gastric conduit reconstruction, after esophagectomy for esophageal squamous cell carcinoma (ESCC), on post-operative outcomes.

Methods

We analyzed 298 patients who underwent radical esophagectomy for ESCC at three high volume centers between 2008 and 2009. Among them, the RS was selected in 166 patients and PM in 118; while, the antethoracic route was used in 14 patients. Post-operative morbidity, mortality, and long-term outcome were compared.

Results

There were no differences between patients of the two routes with respect to operative blood loss (RS: 753 ± 519, PM: 748 ± 414 g) and post-operative complications, including pulmonary problems (RS: 15 %, PM: 10.2 %) and anastomotic leakage (RS: 9.0 %, PM: 5.1 %); although, the operating time (RS: 566 ± 97, PM: 472 ± 79 min; p < 0.0001) was shorter in the PM group than the RS group. The percentage weight loss after surgery was significantly less in the PM group than the RS group at 1 year (8.6 vs. 11.1 %; p = 0.025); although, the percentage at discharge was not different between the groups (PM: 4.9 %, RS: 6.3 %; p = 0.072). Multivariate analysis identified pre-operative body weight and the reconstruction route as significant and independent factors associated with 1-year weight loss.

Conclusions

The results indicate gastric tube reconstruction through the posterior mediastinal route after esophagectomy may relieve post-operative 1-year malnutrition without increasing post-operative complications.

Putnam JB Jr, Suell DM, McMurtrey MJ et al (1994) Comparison of three techniques of esophagectomy within a residency training program. Ann Thorac Surg 57(2):319–325PubMedCrossRef

McCulloch P, Ward J, Tekkis PP (2003) Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 327(7425):1192–1197PubMedCentralPubMedCrossRef

Martin L, Lagergren J, Lindblad M et al (2007) Malnutrition after oesophageal cancer surgery in Sweden. Br J Surg 94(12):1496–1500PubMedCrossRef

Martin L, Lagergren P (2009) Long-term weight change after oesophageal cancer surgery. Br J Surg 96(11):1308–1314PubMedCrossRef

Bozzetti F (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17(3):279–284PubMedCrossRef

Odlund Olin A, Koochek A, Ljungqvist O et al (2005) Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr 59:263–270PubMedCrossRef

Sweed MR, Schiech L, Barsevick A et al (2002) Quality of life after esophagectomy for cancer. Oncol Nurs Forum 29(7):1127–1131PubMedCrossRef

Blazeby JM, Farndon JR, Donovan J et al (2000) A prospective longitudinal study examining the quality of life of patients with esophageal carcinoma. Cancer 88:1781PubMedCrossRef

Djarv T, Blazeby JM, Lagergren P (2009) Predictors of postoperative quality of life after esophagectomy for cancer. J Clin Oncol 27:1963–1968PubMedCrossRef

10.

Ozawa S, Tachimori Y, Baba H et al (2011) Comprehensive Registry of Esophageal Cancer in Japan, 2003. Esophagus 8:9–29CrossRef

11.

Gawad KA, Hosch SB, Bumann D et al (1999) How important is the route of reconstruction after esophagectomy: a prospective randomized study. Am J Gastroenterol 94(6):1490–1496PubMedCrossRef

12.

Wong AC, Law S, Wong J (2003) Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer. Dig Surg 20:209–214PubMedCrossRef

13.

van Lanschot JJ, van Blankenstein M, Oei HY et al (1999) Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma. Br J Surg 86:102–108PubMedCrossRef

14.

Urschel JD, Urschel DM, Miller JD et al (2001) A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg 182(5):470–475PubMedCrossRef

15.

Khiria LS, Pal S, Peush S et al (2009) Impact on outcome of the route of conduit transposition after transhiatal oesophagectomy: a randomized controlled trial. Dig Liver Dis 41(10):711–716PubMedCrossRef

16.

Wang H, Tan L, Feng M et al (2011) Comparison of the short-term health-related quality of life in patients with esophageal cancer with different routes of gastric tube reconstruction after minimally invasive esophagectomy. Qual Life Res 20(2):179–189PubMedCrossRef

17.

Yamasaki M, Miyata H, Fujiwara Y et al (2011) Minimally invasive esophagectomy for esophageal cancer: comparative analysis of open and hand-assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction. J Surg Oncol 104(6):623–628PubMedCrossRef

18.

Shiozaki H, Yano M, Tsujinaka T et al (2001) Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus 14(3–4):191–196PubMedCrossRef

19.

Yoshioka S, Fujiwara Y, Sugita Y et al (2002) Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers. Surgery 132(1):34–40PubMedCrossRef

20.

Miyata H, Yano M, Doki Y et al (2006) A prospective trial for avoiding cervical lymph node dissection for thoracic esophageal cancers, based on intra-operative genetic diagnosis of micrometastasis in recurrent laryngeal nerve chain nodes. J Surg Oncol 93(6):477–484PubMedCrossRef

21.

Yamashita Y, Hirai T, Mukaida H, Yoshimoto A, Kuwahara M, Inoue H, Toge T (1999) Finger bougie method compared with pyloroplasty in the gastric replacement of the esophagus. Surg Today 29(2):107–110PubMedCrossRef

22.

Schiesser M, Kirchhoff P, Muller MK et al (2009) The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery 145(5):519–526PubMedCrossRef

23.

Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nippon Geka Gakkai Zasshi 85:1001–1005PubMed

24.

Ando N, Iizuka T, Ide H et al (2003) Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study. J Clin Oncol 21(24):4592–4596PubMedCrossRef

25.

Mannel A, McKnight A, Esser JD (1990) Role of pyloroplasty in the retrosternal stomach: results of a prospective, randomized controlled trial. Br J Surg 77:57–59CrossRef

26.

Ngan SYK, Wong J (1986) Lengths of different routes for esophageal replacement. J Thorac Cardiovasc Surg 91:790–792PubMed

27.

Bartels H, Thorban S, Siewert JR (1993) Anterior versus posterior reconstruction after transhial oesophagectomy: a randomized controlled trial. Br J Surg 80:1141–1144PubMedCrossRef

28.

Lee Y, Fujita H, Yamana H et al (1994) Factors affecting leakage following esophageal anastomosis. Surg Today 24:24–29PubMedCrossRef

29.

Orringer MB, Marshall B, Chang AC et al (2007) Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg 246:363–374PubMedCentralPubMedCrossRef

30.

Martin L, Jia C, Rouvelas I et al (2008) Risk factors for malnutrition after oesophageal and cardia cancer surgery. Br J Surg 95:1362–1368PubMedCrossRef

Title: Impact of the Route of Reconstruction on Post-operative Morbidity and Malnutrition after Esophagectomy: A Multicenter Cohort Study
Authors: Makoto Yamasaki
Hiroshi Miyata
Takushi Yasuda
Osamu Shiraishi
Tsuyoshi Takahashi
Masaaki Motoori
Masahiko Yano
Hitoshi Shiozaki
Masaki Mori
Yuichiro Doki
Publication date: 01-02-2015
Publisher: Springer US
Published in: World Journal of Surgery / Issue 2/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2819-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of the Route of Reconstruction on Post-operative Morbidity and Malnutrition after Esophagectomy: A Multicenter Cohort Study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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