Top

Published in:

Open Access 01-12-2018 | Research article

Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study

Authors: Shinichiro Kobayashi, Kengo Kanetaka, Yasuhiro Nagata, Masahiko Nakayama, Ryo Matsumoto, Mitsuhisa Takatsuki, Susumu Eguchi

Published in: BMC Surgery | Issue 1/2018

Abstract

Background

Regardless of developments in thoracoscopic esophagectomy (TE), postoperative complications relative to gastric conduit reconstruction are common after esophagectomy. The aim of the present study was to evaluate the predictive factors of major complications related to gastric conduit after TE.

Methods

From 2006 to 2015, 75 patients with esophageal cancer who underwent TE were evaluated to explore the predictive factors of major postoperative complications related to gastric conduit.

Results

Patients with major complications related to gastric conduit had a significantly longer postoperative hospital stay than patients without these complications (P < 0.01). Multivariate analysis demonstrated that three-field lymph node dissection (3FLND) and high serum levels of creatine phosphokinase (CPK) and C-reactive protein (CRP) at 1 postoperative day (1POD) after TE were significant predictive factors of major complications related to gastric conduit [odds ratio (OR) 5.37, 95% confidence interval (CI) 1.41–24.33, P = 0.02; OR 5.40, 95% CI 1.60–20.20, P < 0.01; OR 5.07, 95% CI 1.47–20.25, P = 0.01, respectively]. The incidence rates of major complications related to gastric conduit for 0, 1, 2, and 3 predictive factors were 5.3%, 18.8%, 58.8%, and 85.7%, respectively (P < 0.01).

Conclusions

Two or more factors in 3FLND and the high levels of CPK and CRP at 1POD after TE were identified as the risk model for major complications related to gastric conduit after TE.

Trial registration

UMIN Clinical Trials Registry, ID: UMIN000024436, Registered date: Oct/17/2016.

Verhage RJ, Hazebroek EJ, Boone J, Van Hillegersberg R. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir. 2009;64(2):135–46.PubMed

Blencowe NS, Strong S, McNair AG, Brookes ST, Crosby T, Griffin SM, Blazeby JM. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg. 2012;255(4):658–66.CrossRefPubMed

Dhungel B, Diggs BS, Hunter JG, Sheppard BC, Vetto JT, Dolan JP. Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008. J Gastrointest Surg. 2010;14(10):1492–501.CrossRefPubMed

Mamidanna R, Bottle A, Aylin P, Faiz O, Hanna GB. Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg. 2012;255(2):197–203.CrossRefPubMed

Takeuchi H, Miyata H, Gotoh M, Kitagawa Y, Baba H, Kimura W, Tomita N, Nakagoe T, Shimada M, Sugihara K, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260(2):259–66.CrossRefPubMed

Yerokun BA, Sun Z, Yang CJ, Gulack BC, Speicher PJ, Adam MA, D'Amico TA, Onaitis MW, Harpole DH, Berry MF, et al. Minimally invasive versus open Esophagectomy for esophageal cancer: a population-based analysis. Ann Thorac Surg. 2016;102(2):416–23.CrossRefPubMedPubMedCentral

Takeuchi H, Miyata H, Ozawa S, Udagawa H, Osugi H, Matsubara H, Konno H, Seto Y, Kitagawa Y. Comparison of short-term outcomes between open and minimally invasive Esophagectomy for esophageal cancer using a Nationwide database in Japan. Ann Surg Oncol. 2017;24(7):1821–7.CrossRefPubMed

Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND. Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg. 2014;259(3):413–31.CrossRefPubMed

Honda M, Kuriyama A, Noma H, Nunobe S, Furukawa TA. Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy: a systematic review and meta-analysis. Ann Surg. 2013;257(2):238–48.CrossRefPubMed

10.

Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg. 2004;16(2):124–32.CrossRefPubMed

11.

Nishikawa K, Fujita T, Yuda M, Yamamoto S, Tanaka Y, Matsumoto A, Tanishima Y, Yano F, Mitsumori N, Yanaga K. Early postoperative endoscopy for targeted management of patients at risks of anastomotic complications after esophagectomy. Surgery. 2016;160(5):1294–301.CrossRefPubMed

12.

Fujiwara H, Nakajima Y, Kawada K, Tokairin Y, Miyawaki Y, Okada T, Nagai K, Kawano T. Endoscopic assessment 1 day after esophagectomy for predicting cervical esophagogastric anastomosis-relating complications. Surg Endosc. 2016;30(4):1564–71.CrossRefPubMed

13.

Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, Shimada H, Takiuchi H, Toh Y, Doki Y, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan esophageal society. Esophagus. 2015;12(1):1–30.CrossRefPubMed

14.

Edge SB BD, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer-Verlag; 2009. p.103–15.

15.

Li H, Yang S, Zhang Y, Xiang J, Chen H. Thoracic recurrent laryngeal lymph node metastases predict cervical node metastases and benefit from three-field dissection in selected patients with thoracic esophageal squamous cell carcinoma. J Surg Oncol. 2012;105(6):548–52.CrossRefPubMed

16.

Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13(3):569–75.CrossRefPubMed

17.

Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005;62(3):474–5.CrossRefPubMed

18.

Yano T, Yoda Y, Nomura S, Toyosaki K, Hasegawa H, Ono H, Tanaka M, Morimoto H, Horimatsu T, Nonaka S, et al. Prospective trial of biodegradable stents for refractory benign esophageal strictures after curative treatment of esophageal cancer. Gastrointest Endosc. 2017;86(3):492–9.CrossRefPubMed

19.

Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.CrossRefPubMed

20.

Lasko TA, Bhagwat JG, Zou KH, Ohno-Machado L. The use of receiver operating characteristic curves in biomedical informatics. J Biomed Inform. 2005;38(5):404–15.CrossRefPubMed

21.

Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379(9829):1887–92.CrossRefPubMed

22.

Straatman J, van der Wielen N, Cuesta MA, Daams F, Roig Garcia J, Bonavina L, Rosman C, van Berge Henegouwen MI, Gisbertz SS, van der Peet DL. Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Ann Surg. 2017;266(2):232–6.CrossRefPubMed

23.

Decker G, Coosemans W, De Leyn P, Decaluwe H, Nafteux P, Van Raemdonck D, Lerut T. Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg. 2009;35(1):13–21.

24.

Hirahara N, Matsubara T, Mizota Y, Ishibashi S, Tajima Y. Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy. BMC Surg. 2016;16(1):66.CrossRefPubMedPubMedCentral

25.

Baba Y, Yoshida N, Shigaki H, Iwatsuki M, Miyamoto Y, Sakamoto Y, Watanabe M, Baba H. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264(2):305–11.CrossRefPubMed

26.

Tsurumaru M, Kajiyama Y, Udagawa H, Akiyama H. Outcomes of extended lymph node dissection for squamous cell carcinoma of the thoracic esophagus. Ann Thorac Cardiovasc Surg. 2001;7(6):325–9.PubMed

27.

Tachibana M, Kinugasa S, Yoshimura H, Shibakita M, Tonomoto Y, Dhar DK, Nagasue N. Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg. 2005;189(1):98–109.CrossRefPubMed

28.

Hsu WH, Hsu PK, Hsieh CC, Huang CS, Wu YC. The metastatic lymph node number and ratio are independent prognostic factors in esophageal cancer. J Gastrointest Surg. 2009;13(11):1913–20.CrossRefPubMed

29.

Japan Esophageal Society. Japanese classification of esophageal cancer. 11th edition, part I. Esophagus. 2017;17(1):1–36.

30.

Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Ectors N. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240(6):962–74.

31.

Chen J, Wu S, Zheng X, Pan J, Zhu K, Chen Y, Li J, Liao L, Lin Y, Liao Z. Cervical lymph node metastasis classified as regional nodal staging in thoracic esophageal squamous cell carcinoma after radical esophagectomy and three-field lymph node dissection. BMC Surg. 2014;14:110.CrossRefPubMedPubMedCentral

32.

Ye T, Sun Y, Zhang Y, Chen H. Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. Ann Thorac Surg. 2013;96(6):1933–41.CrossRefPubMed

33.

Ma GW, Situ DR, Ma QL, Long H, Zhang LJ, Lin P, Rong TH. Three-field vs two-field lymph node dissection for esophageal cancer: a meta-analysis. World J Gastroenterol. 2014;20(47):18022–30.CrossRefPubMedPubMedCentral

34.

Zheng QF, Wang JJ, Ying MG, Liu SY. Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy. Eur J Cardiothorac Surg. 2013;43(2):274–8.CrossRefPubMed

35.

Chen H, Lu JJ, Zhou J, Zhou X, Luo X, Liu Q, Tam J. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study. Ann Thorac Surg. 2009;87(2):400–4.CrossRefPubMed

36.

Hu H, Ye T, Tan D, Li H, Chen H. Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study. Eur J Cardiothorac Surg. 2011;40(6):1466–9.PubMed

37.

Urschel JD, Urschel DM, Miller JD, Bennett WF, Young JE. A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg. 2001;182(5):470–5.CrossRefPubMed

38.

Tachimori Y, Ozawa S, Numasaki H, Ishihara R, Matsubara H, Muro K, Oyama T, Toh Y, Udagawa H, Uno T. Comprehensive registry of esophageal cancer in Japan, 2010. Esophagus. 2017;14(3):189–214.CrossRefPubMedPubMedCentral

39.

Miki Y, Toyokawa T, Kubo N, Tamura T, Sakurai K, Tanaka H, Muguruma K, Yashiro M, Hirakawa K, Ohira M. C-reactive protein indicates early stage of postoperative infectious complications in patients following minimally invasive Esophagectomy. World J Surg. 2017;41(3):796–803.CrossRefPubMed

40.

Hoeboer SH, Groeneveld AB, Engels N, van Genderen M, Wijnhoven BP, van Bommel J. Rising C-reactive protein and procalcitonin levels precede early complications after esophagectomy. J Gastrointest Surg. 2015;19(4):613–24.CrossRefPubMedPubMedCentral

41.

Kanda T, Nakatomi Y, Ishikawa H, Hitomi M, Matsubara Y, Ono T, Muto T. Intestinal fatty acid-binding protein as a sensitive marker of intestinal ischemia. Dig Dis Sci. 1992;37(9):1362–7.CrossRefPubMed

42.

Kanda T, Tsukahara A, Ueki K, Sakai Y, Tani T, Nishimura A, Yamazaki T, Tamiya Y, Tada T, Hirota M, et al. Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study. J Gastroenterol. 2011;46(4):492–500.CrossRefPubMed

43.

van der Voort PH, Westra B, Wester JP, Bosman RJ, van Stijn I, Haagen IA, Loupatty FJ, Rijkenberg S. Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia. BMC Anesthesiol. 2014;14:111.CrossRefPubMedPubMedCentral

44.

Oezcelik A, Banki F, Ayazi S, Abate E, Zehetner J, Sohn HJ, Hagen JA, DeMeester SR, Lipham JC, Palmer SL, et al. Detection of gastric conduit ischemia or anastomotic breakdown after cervical esophagogastrostomy: the use of computed tomography scan versus early endoscopy. Surg Endosc. 2010;24(8):1948–51.CrossRefPubMed

45.

Page RD, Asmat A, McShane J, Russell GN, Pennefather SH. Routine endoscopy to detect anastomotic leakage after esophagectomy. Ann Thorac Surg. 2013;95(1):292–8.CrossRefPubMed

46.

Schaible A, Sauer P, Hartwig W, Hackert T, Hinz U, Radeleff B, Büchler MW, Werner J. Radiologic versus endoscopic evaluation of the conduit after esophageal resection: a prospective, blinded, intraindividually controlled diagnostic study. Surg Endosc. 2014;28(7):2078–85.CrossRefPubMed

47.

Dewar L, Gelfand G, Finley RJ, Evans K, Inculet R, Nelems B. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg. 1992;163(5):484–9.CrossRefPubMed

48.

Walther B, Johansson J, Johnsson F, Von Holstein CS, Zilling T. Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg. 2003;238(6):803–14.

49.

Zhang YS, Gao BR, Wang HJ, Su YF, Yang YZ, Zhang JH, Wang C. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer: a prospective randomized controlled trial. J Int Med Res. 2010;38(1):227–33.CrossRefPubMed

50.

Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol. 2010;101(6):527–33.CrossRefPubMed

51.

Xu QR, Wang KN, Wang WP, Zhang K, Chen LQ. Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study. J Gastrointest Surg. 2011;15(6):915–21.CrossRefPubMed

52.

Law S, Fok M, Chu KM, Wong J. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg. 1997;226(2):169–73.CrossRefPubMedPubMedCentral

53.

Muramatsu N, Liang J. Hospital length of stay in the United States and Japan: a case study of myocardial infarction patients. Int J Health Serv. 1999;29(1):189–209.CrossRefPubMed

54.

Akkerman RD, Haverkamp L, van Hillegersberg R, Ruurda JP. Surgical techniques to prevent delayed gastric emptying after esophagectomy with gastric interposition: a systematic review. Ann Thorac Surg. 2014;98(4):1512–9.CrossRefPubMed

55.

Poghosyan T, Gaujoux S, Chirica M, Munoz-Bongrand N, Sarfati E, Cattan P. Functional disorders and quality of life after esophagectomy and gastric tube reconstruction for cancer. J Visc Surg. 2011;148(5):e327–35.CrossRefPubMed

Title: Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study
Authors: Shinichiro Kobayashi
Kengo Kanetaka
Yasuhiro Nagata
Masahiko Nakayama
Ryo Matsumoto
Mitsuhisa Takatsuki
Susumu Eguchi
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2018
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-018-0348-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2018

Perioperative dynamics and significance of plasma-free amino acid profiles in colorectal cancer

Wide excision and reconstruction surgery for recurrent sweat gland umbilical adenocarcinoma followed by chemotherapy can prevent the risk of recurrences

Sporadic Abdominal Wall Desmoid type Fibromatosis: treatment paradigm after thirty two years

Extended left hepatectomy for intrahepatic cholangiocarcinoma: hepatic vein reconstruction with in-situ hypothermic perfusion and extracorporeal membrane oxygenation

Robotic enucleation for pediatric insulinoma with MEN1 syndrome: a case report and literature review

Blunt liver trauma: a descriptive analysis from a level I trauma center