Early Postoperative Endoscopy for Evaluation of the Anastomosis after Esophageal Reconstruction
Journal
Thoracic and Cardiovascular Surgeon
Journal Volume
66
Journal Issue
5
Pages
376-383
Date Issued
2017
Author(s)
Abstract
Background Anastomotic leaks significantly affect hospital stay after esophageal surgery. Here, we investigated the efficacy of early endoscopy for predicting anastomotic healing and leaks after esophageal reconstruction. Methods A total of 65 consecutive esophageal cancer patients treated by cervical esophagogastrostomy underwent routine endoscopy between postoperative days 5 and 7. The anastomosis was scored for the degree of ischemia, stenosis, and torsion of the anastomotic axis. Independent associations between ischemia, stenosis, and torsion of the proximal esophagus and the risk of the anastomotic leak were examined using Spearman's rank correlation method. Results Assessment of the degree of mucosal ischemia in 65 patients shows well healing in 35, patch ischemia in 20, diffuse ischemia in 10, no necrosis in any patient. Stenosis was classified as 0 to 10% in 40 patients, 11 to 20% in 12, 21 to 80% in 11, and 81 to 100% in 2. The degree of torsion of the anastomotic axis was classified as 0 to 10 degrees in 52 patients, 11 to 90 degrees in 8, and 91 to 180 degrees in 5. With rising endoscopy scores, there was an increase in risk for leaks (score > 4.5, sensitivity 100%, and specificity 83.8%). Conclusions Early postoperative endoscopy facilitates the management of esophagogastrostomy anastomosis to predict leaks. ? 2018 Georg Thieme Verlag KG.
SDGs
Other Subjects
cisplatin; adjuvant chemoradiotherapy; adjuvant therapy; adult; aged; anastomosis diffuse ischemia; anastomosis leakage; anastomosis patch ischemia; anastomosis stenosis; Article; cancer surgery; cervical esophagogastrostomy; comparative study; controlled study; early diagnosis; esophagogastrostomy; esophagoscopy; esophagostomy; esophagus anastomosis; esophagus cancer; esophagus injury; esophagus mucosa; esophagus reconstruction; esophagus resection; female; human; ischemia; laparotomy; major clinical study; male; necrosis; neoadjuvant chemotherapy; postoperative care; postoperative complication; prediction; priority journal; proximal esophagus torsion; pyloromyotomy; pyloroplasty; stomach mucosa; surgical patient; surgical risk; therapy effect; wound healing; anastomosis; anastomosis leakage; area under the curve; esophagus resection; esophagus stenosis; esophagus tumor; gastrostomy; ischemia; middle aged; pathology; predictive value; procedures; receiver operating characteristic; reconstructive surgery; reproducibility; time factor; torsion; treatment outcome; wound healing; Adult; Aged; Anastomosis, Surgical; Anastomotic Leak; Area Under Curve; Esophageal Neoplasms; Esophageal Stenosis; Esophagectomy; Esophagoscopy; Esophagostomy; Female; Gastrostomy; Humans; Ischemia; Male; Middle Aged; Necrosis; Predictive Value of Tests; Reconstructive Surgical Procedures; Reproducibility of Results; ROC Curve; Time Factors; Torsion Abnormality; Treatment Outcome; Wound Healing
Type
journal article