Abstract
BackgroundPylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Currently, controversy remains regarding the need for these practices. The present study aimed to determine the value and role of pyloric drainage procedures in esophagectomy with gastric replacement.MethodsA retrospective review of prospectively collected data was performed for all consecutive patients who underwent thoracoabdominal resection of the esophagus between January 2009 and December 2016 at the Katharinenhospital in Stuttgart, Germany. Clinicopathologic features and surgical outcomes were evaluated with a focus on postoperative nutrition and gastric emptying.ResultsThe study group included 170 patients who underwent thoracoabdominal esophageal resection with a gastric conduit using the Ivor Lewis approach. The median age of the patients was 64 years. Most patients were male (81%), and most suffered from adenocarcinoma of the esophagus (75%). The median hospital stay was 20 days, and the 30-day hospital death rate was 2.9%. According to the department standard, pylorotomy, pyloroplasty, or other pyloric drainage procedures were not performed in any of the patients. Overall, 28/170 patients showed clinical signs of DGE (16.5%).ConclusionsIn the literature, the rate of DGE after thoracoabdominal esophagectomy is reported to be approximately 15%, even with the use of pyloric drainage procedures. This rate is comparable to that reported in the present series in which no pyloric drainage procedures were performed. Therefore, we believe that pyloric drainage procedures may be unwarranted in thoracoabdominal esophagectomy. However, future randomized trials are needed to ultimately confirm this supposition.
Highlights
Pylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy
Three patients had neuroendocrine tumors of the esophagus (1.8%), and one patient suffered from a gastrointestinal stroma tumor (GIST)
The present study aimed to evaluate surgical outcomes following esophagectomy with gastric replacement with a special focus on gastric outlet obstruction in a large singlecenter series
Summary
Pylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Thoracoabdominal esophagectomy for esophageal cancer has been associated with high rates of morbidity and mortality in the past. Until the 1980s, postoperative inhospital death rates were reported to range around 30% [1, 2]. Along with improvements in periand postoperative outcomes, surgical techniques have been evaluated with regard to non-life-threatening postoperative complications and quality of life. Depending on the definition and the surgical technique performed, clinical symptoms during the postoperative course reportedly occur in 10% to 50% of patients [6, 7]. Gastric outlet obstruction results from truncal vagotomy and is thought to be associated with an increased incidence of postoperative complications, including aspiration with subsequent pneumonia and anastomotic leaks. DGE is reported to lead to decreased patient satisfaction and a prolonged hospital stay [8,9,10]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
