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Published in: World Journal of Surgery 5/2015

01-05-2015 | Original Scientific Report

Outcomes of Cervical End-to-Side Triangulating Esophagogastric Anastomosis with Minimally Invasive Esophagectomy

Authors: Kohei Nakata, Eishi Nagai, Kenoki Ohuchida, Katsuya Nakamura, Masao Tanaka

Published in: World Journal of Surgery | Issue 5/2015

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Abstract

Background

Esophagogastric anastomosis after esophagectomy has been performed with a variety of techniques during the past decade. However, anastomotic leakage and stricture are still important clinical problems after esophagogastric anastomosis, causing burdensome symptoms and poor quality of life. Herein, we describe a novel cervical end-to-side triangulating esophagogastric anastomoasis using linear stapler.

Methods

A total of 90 patients (85 % male; mean age 63 years) with thoracic esophageal cancer who underwent cervical end-to-side esophagogastric triangular anastomosis using a linear stapler after minimally invasive esophagectomy between November 2006 and April 2013 were retrospectively reviewed.

Results

The median operation time was 602 min (range 424–936 min). The volume of blood loss during the entire operative procedure was 127 ml (range 0–700 ml). There were no cases of anastomotic leakage in this study, although four patients (4.4 %) developed dysphagia associated with benign anastomotic stricture formation. All patients with a benign anastomotic stricture underwent balloon dilation, which resulted in improvement in their symptoms.

Conclusions

Considering the absence of anastomotic leakage and low rate of anastomotic stricture formation in this study, our modified triangular esophagogastric anastomosis technique appears promising and may contribute to reduced morbidity and mortality rates following esophagectomy.
Literature
1.
go back to reference Mamidanna R, Bottle A, Aylin P et al (2012) Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 255:197–203CrossRefPubMed Mamidanna R, Bottle A, Aylin P et al (2012) Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 255:197–203CrossRefPubMed
2.
go back to reference Dewar L, Gelfand G, Finley RJ et al (1992) Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg 163:484–489CrossRefPubMed Dewar L, Gelfand G, Finley RJ et al (1992) Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg 163:484–489CrossRefPubMed
3.
go back to reference Robertson GS, Lloyd DM, Wicks AC et al (1996) No obvious advantages for thoracoscopic two-stage oesophagectomy. Br J Surg 83:675–678CrossRefPubMed Robertson GS, Lloyd DM, Wicks AC et al (1996) No obvious advantages for thoracoscopic two-stage oesophagectomy. Br J Surg 83:675–678CrossRefPubMed
4.
go back to reference Valverde A, Hay JM, Fingerhut A et al (1996) Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research. Surgery 120:476–483CrossRefPubMed Valverde A, Hay JM, Fingerhut A et al (1996) Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research. Surgery 120:476–483CrossRefPubMed
5.
go back to reference Law S, Fok M, Chu KM et al (1997) Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 226:169–173CrossRefPubMedCentralPubMed Law S, Fok M, Chu KM et al (1997) Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 226:169–173CrossRefPubMedCentralPubMed
6.
go back to reference Saluja SS, Ray S, Pal S et al (2012) Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck. J Gastrointest Surg 16:1287–1295CrossRefPubMed Saluja SS, Ray S, Pal S et al (2012) Randomized trial comparing side-to-side stapled and hand-sewn esophagogastric anastomosis in neck. J Gastrointest Surg 16:1287–1295CrossRefPubMed
7.
go back to reference Haverkamp L, Van der Sluis PC, Verhage RJ et al (2013) End-to-end cervical esophagogastric anastomoses are associated with a higher number of strictures compared with end-to-side anastomoses. J Gastrointest Surg 17:872–876CrossRefPubMed Haverkamp L, Van der Sluis PC, Verhage RJ et al (2013) End-to-end cervical esophagogastric anastomoses are associated with a higher number of strictures compared with end-to-side anastomoses. J Gastrointest Surg 17:872–876CrossRefPubMed
8.
go back to reference Van Heijl M, Gooszen JA, Fockens P et al (2010) Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg 251:1064–1069CrossRefPubMed Van Heijl M, Gooszen JA, Fockens P et al (2010) Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg 251:1064–1069CrossRefPubMed
9.
go back to reference Honda M, Kuriyama A, Noma H et al (2013) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg 257:238–248CrossRefPubMed Honda M, Kuriyama A, Noma H et al (2013) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg 257:238–248CrossRefPubMed
10.
go back to reference Xu QR, Wang KN, Wang WP et al (2011) Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study. J Gastrointest Surg 15:915–921CrossRefPubMed Xu QR, Wang KN, Wang WP et al (2011) Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study. J Gastrointest Surg 15:915–921CrossRefPubMed
11.
go back to reference Nederlof N, Tilanus HW, Tran TC et al (2011) End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg 254:226–233CrossRefPubMed Nederlof N, Tilanus HW, Tran TC et al (2011) End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg 254:226–233CrossRefPubMed
12.
go back to reference Johansson J, Oberg S, Wenner J et al (2009) Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial. Ann Surg 250:667–673CrossRefPubMed Johansson J, Oberg S, Wenner J et al (2009) Impact of proton pump inhibitors on benign anastomotic stricture formations after esophagectomy and gastric tube reconstruction: results from a randomized clinical trial. Ann Surg 250:667–673CrossRefPubMed
13.
go back to reference Furukawa Y, Hanyu N, Hirai K et al (2005) Usefulness of automatic triangular anastomosis for esophageal cancer surgery using a linear stapler (TA-30). Ann Thorac Cardiovasc Surg 11:80–86PubMed Furukawa Y, Hanyu N, Hirai K et al (2005) Usefulness of automatic triangular anastomosis for esophageal cancer surgery using a linear stapler (TA-30). Ann Thorac Cardiovasc Surg 11:80–86PubMed
14.
go back to reference Noshiro H, Urata M, Ikeda O et al (2013) Triangulating stapling technique for esophagogastrostomy after minimally invasive esophagectomy. Surgery 154:604–610CrossRefPubMed Noshiro H, Urata M, Ikeda O et al (2013) Triangulating stapling technique for esophagogastrostomy after minimally invasive esophagectomy. Surgery 154:604–610CrossRefPubMed
15.
go back to reference Toh Y, Sakaguchi Y, Ikeda O et al (2009) The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today 39:201–206CrossRefPubMed Toh Y, Sakaguchi Y, Ikeda O et al (2009) The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today 39:201–206CrossRefPubMed
16.
go back to reference Takemura M, Yoshida K, Fujiwara Y (2013) Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc 27:1249–1253CrossRefPubMedCentralPubMed Takemura M, Yoshida K, Fujiwara Y (2013) Modified triangulating stapling technique for esophagogastrostomy after esophagectomy for esophageal cancer. Surg Endosc 27:1249–1253CrossRefPubMedCentralPubMed
17.
go back to reference Mellow MH, Pinkas H (1985) Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction. Analysis of technical and functional efficacy. Arch Intern Med 145:1443–1446CrossRefPubMed Mellow MH, Pinkas H (1985) Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction. Analysis of technical and functional efficacy. Arch Intern Med 145:1443–1446CrossRefPubMed
18.
go back to reference Jaroszewski DE, Williams DG, Fleischer DE et al (2011) An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg 92:1862–1869CrossRefPubMed Jaroszewski DE, Williams DG, Fleischer DE et al (2011) An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg 92:1862–1869CrossRefPubMed
19.
go back to reference Schilling MK, Redaelli C, Maurer C et al (1996) Gastric microcirculatory changes during gastric tube formation: assessment with laser Doppler flowmetry. J Surg Res 62:125–129CrossRefPubMed Schilling MK, Redaelli C, Maurer C et al (1996) Gastric microcirculatory changes during gastric tube formation: assessment with laser Doppler flowmetry. J Surg Res 62:125–129CrossRefPubMed
20.
go back to reference Maclaren R, Reynolds PM, Allen RR (2014) Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med 174:564–574CrossRefPubMed Maclaren R, Reynolds PM, Allen RR (2014) Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit. JAMA Intern Med 174:564–574CrossRefPubMed
21.
go back to reference Williams VA, Watson TJ, Zhovtis S et al (2008) Endoscopic and symptomatic assessment of anastomotic strictures following esophagectomy and cervical esophagogastrostomy. Surg Endosc 22:1470–1476CrossRefPubMed Williams VA, Watson TJ, Zhovtis S et al (2008) Endoscopic and symptomatic assessment of anastomotic strictures following esophagectomy and cervical esophagogastrostomy. Surg Endosc 22:1470–1476CrossRefPubMed
22.
go back to reference Kayani B, Jarral OA, Athanasiou T et al (2012) Should oesophagectomy be performed with cervical or intrathoracic anastomosis? Interact Cardiovasc Thorac Surg 14:821–826CrossRefPubMedCentralPubMed Kayani B, Jarral OA, Athanasiou T et al (2012) Should oesophagectomy be performed with cervical or intrathoracic anastomosis? Interact Cardiovasc Thorac Surg 14:821–826CrossRefPubMedCentralPubMed
23.
go back to reference Egberts JH, Schniewind B, Bestmann B et al (2008) Impact of the site of anastomosis after oncologic esophagectomy on quality of life—a prospective, longitudinal outcome study. Ann Surg Oncol 15:566–575CrossRefPubMed Egberts JH, Schniewind B, Bestmann B et al (2008) Impact of the site of anastomosis after oncologic esophagectomy on quality of life—a prospective, longitudinal outcome study. Ann Surg Oncol 15:566–575CrossRefPubMed
24.
go back to reference Price TN, Nichols FC, Harmsen WS et al (2013) A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg 95:1154–1161CrossRefPubMed Price TN, Nichols FC, Harmsen WS et al (2013) A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg 95:1154–1161CrossRefPubMed
Metadata
Title
Outcomes of Cervical End-to-Side Triangulating Esophagogastric Anastomosis with Minimally Invasive Esophagectomy
Authors
Kohei Nakata
Eishi Nagai
Kenoki Ohuchida
Katsuya Nakamura
Masao Tanaka
Publication date
01-05-2015
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 5/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2925-0

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