Prediction of need for multiple dilatations after cervical oesophagogastrostomy

Abstract

Abstract Background The aim of this study was to investigate the frequency of anastomotic stricture formation after subtotal oesophagectomy with cervical oesophagogastrostomy. Methods Patients undergoing surgery over a 3-year period using an identical handsewn single-layer anastomotic technique were studied. Details of the operations, complications and need for anastomotic dilatation were recorded. Results Sixty-two patients (41 men) with a mean age of 64 (range 36–90) years were included. Fifty-eight underwent surgery for carcinoma, two for stromal tumours, one for achalasia and one for Crohn's disease. Thirty-two (2 per cent) developed a benign anastomotic stricture requiring a median of 4 (range 1–22) dilatations. The median time from operation to first dilatation was 50 days. There was a significant correlation between the time to first dilatation and the total number of dilatations (P = 0·006). Patients who developed symptomatic strictures within 30 days of operation required a median of 9·5 dilatations compared with 3·5 in those who presented beyond this time (P = 0·01). The development of a clinical leak significantly increased the number of dilatations required, from a mean of 5·2 to 10·4 (P = 0·04). Conclusion The incidence of benign anastomotic stricture formation requiring dilatation after cervical oesophagogastrostomy is about 50 per cent. Patients who require dilatation within 30 days of surgery to restore swallowing to normal are likely to require the procedure on multiple occasions and should be counselled accordingly.