Korean J Thorac Cardiovasc Surg.
1999 Sep;32(9):799-805.
A Study on Anastomotic Complications after Esophagectomy for Cancer
of the Esophagus: A Comparison of Neck and Chest Anastomosis
- Affiliations
-
- 1Department of Thoracic and Cardiovascular Surgery, College of Medicine,
Pusan National University. hrlee@hyowon.pusan.ac.kr
Abstract
-
BACKGROUND: Leakage, stricture formation, and tumor recurrence at the anastomotic site are
serious problems after esophagectomy for cancer of the esophagus or cardia. The prevalence
of these postoperative complications may be affected by whether an anastomosis is made in
the neck or in the chest, therefore a comparison was made between anastomoses made at these
two sites.
MATERIAL AND METHOD: Between 1987 and 1998, 36 patients with cancer of the esophagus
underwent transthoracic esophagectomy with cervical(NA, n=20) or thoracic anastomosis(CA, n=16).
The tumors were staged postoperatively(stage IIA, n=13; s tage IIB, n=7; stage III, n=16) and
were located in the middle thoracic(n=22) or lower thoracic esophagus and cardia(n=14).
RESULT: The overall operative mortality was 8.3%(5% for NA group, 12.5% for CA group).
The anastomotic leak rate for the NA group was 15.0% and 12.5% for the CA group.
The anastomotic leak rate differed according to the manual(27.3%) or stapled(8.0%)
techniques(p < 0.05). The median proximal resection margins in the NA and CA groups
were 9.6 cm and 5.8 cm, and the corresponding rates of anastomotic tumor recurrence were 5.3%
and 28.6%(p < 0.05). The prevalence of benign stricture formation (defined as moderate/severe
dysphagia) was higher in the NA group(36.8%) than in the CA group(21.4%). When an anastomosis
was made by the stapled technique, smaller size of the staple increased the prevalence of
stricture formation - 41.7% with 25-mm staple and 9.1% with 28-mm staple(p < 0.05).
CONCLUSION
Wider resection margin could decrease the anastomotic tumor recurrence, and the
stapled technique could decrease the anastomotic leak. The prevalence of benign stricture
was higher in the cervical anastomosis but the anastomotic leak and smaller size(25-mm) of
the staple should be considered as risk factors.