Mo1492 Symptomatic and Radiographic Evaluation of Hiatal Hernia Recurrence Following Laparoscopic Paraesophageal Hernia Repair With Polyester Composite Mesh Reinforcement

Abstract

analysed using chi squared for binomial comparisons, the method of Kaplan-Meier for survival estimates, and the log-rank statistic to compare survival between cohorts. Results: Recurrence was detected in 46 cases (37%). Median time to recurrence was 9 months (range 1-108 months). Median time to death from radiological confirmation of recurrence was 4 months (range 1-18 months), increasing to 13 months (range 6-18 months) if the patient subsequently underwent an interventional therapy (Χ2= 25.63, log-rank p<0.001). In nine cases, the recurrences were loco-regional; the remainder had a systemic component. In 12 cases CT detected recurrence in asymptomatic patients; in the remaining 34, suspicious symptoms or tumour marker rise prompted further investigation. Routine-detected recurrences were not more likely to have further interventional treatment for their cancer (Fisher, p=0.519), nor did it confer survival benefit (log-rank, p= 0.532). Subgroup analysis by neoadjuvant therapy, preoperative stage and resection status further confirmed this. Conclusion: Routine CT appeared to detect preclinical recurrences only in a handful of patients who had undergone oesophagectomy. The majority of recurrences were diagnosed when patients presented with symptoms. Our data suggests that routine CT scanning in asymptomatic patients may not add any survival benefit. A well-designed prospective study may give a definitive answer.