Abstract
BackgroundThe aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study.Methods72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates.ResultsAnastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11%) vs. 11 of 36 patients (31%); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10–110) vs. 26 days (range 12 – 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046). The overall In-hospital mortality rate was 6% (4 of 72 patients) without any differences between the study groups.ConclusionsThe present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.
Highlights
The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study
In cases of cancer of the gastroesophageal junction some authors prefer the transhiatal approach with collar anastomosis in order to reduce early postoperative morbidity and mortality rates by avoiding thoracotomy and potential mediastinitis erosed by anastomotic leakage [3,4] despite an increased risk of leakage
One major challenge after esophageal resection remains the occurrence of anastomotic leakage attended by mortality rates up to 50% [7]
Summary
The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. In cases of cancer of the gastroesophageal junction some authors prefer the transhiatal approach with collar anastomosis in order to reduce early postoperative morbidity and mortality rates by avoiding thoracotomy and potential mediastinitis erosed by anastomotic leakage [3,4] despite an increased risk of leakage. Most study groups present their surgical outcome dependent on the surgical approach (either transthoracic or transhiatal) [1,2] we tried to investigate the influence of the position of the esophagogastrostomy (either cervical or intrathoracic) in a single center matched pair analysis
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