Background
Esophagogastrectomy for esophageal cancer is the standard surgical treatment as a
curative measure or for palliation. Esophagogastric anastomotic leakage and stricture
are common life-threatening postoperative complications (more so if the leakage occurs
in the chest), and the success of the anastomosis created in the reconstruction of
the resected esophagus can highly influence morbidity and mortality.
Methods
A prospective, randomized study was undertaken on 291 patients treated for carcinoma
of the esophagus between January 2004 and December 2008. The study excluded 36 patients
(12%) who were inoperable. Patients were assigned to 2 treatment groups that consisted
of 128 patients in group A and 127 patients in group B according to a restricted,
permuted block randomization plan. Patients in group A underwent an esophagogastrectomy
with wrapping of the pedicle omental flap around the esophagogastric anastomosis.
Group B patients underwent an esophagogastrectomy with only a stapled technique.
Results
Of all 255 patients who received an esophagogastric anastomosis, 226 (89%) were discharged
from the hospital within 15 days of operation. There was no significant difference
between these 2 groups in regard to the incidence of pulmonary complications, abdominal
or thoracic infections, and days of hospital stay. Anastomotic leaks occurred in a
single patient from group A (1%) and in 7 patients from group B (6%). In group A,
33 patients underwent transhiatal esophagogastrectomy and 95 had thoracic esophagogastrectomy,
which resulted in an anastomotic leakage in 1 (3%) and 0 (0%) patients, respectively.
In group B, 42 patients had transhiatal esophagogastrectomy and 85 had thoracic esophagogastrectomy,
which resulted in anastomotic leakage in 5 (12%) and 2 (2%) patients, respectively.
The leakage ratio of group B was significant greater than that of group A (P < .05). Two patients were excluded during the evaluation of the benign stricture
due to hospital mortality. Anastomotic strictures were noted in 8 patients from group
A (6%) and 20 patients from group B (16%), and the difference in the incidence of
anastomotic strictures between these 2 groups was statistically significant (P < .05).
Conclusion
Wrapping of the pedicle omental flap around the esophagogastric stapled anastomosis
site decreases the incidence of anastomotic leakage and stricture rate after esophagectomy
for esophageal cancer, thereby decreasing the morbidity and mortality of the procedure.
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Article info
Publication history
Published online: September 20, 2010
Accepted:
August 5,
2010
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
