Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy.

The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326-277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.

[Comparison of short-term outcomes between minimally invasive McKeown esophagectomy and Ivor-Lewis esophagectomy for esophageal cancer].

OBJECTIVE: To summarize the outcomes of 74 patients with minimally invasive McKeown esophagectomy (MIE-McKeown), and to discuss the short-term outcomes by comparing with Ivor-Lewis esophagectomy (ILE) procedure.
 Methods: A total of 74 patients with esophageal carcinoma underwent MIE-McKeown in Xiangya Hospital from November 2014 to July 2016 were retrospectively reviewed, and 85 patients underwent ILE procedure were selected as a control group. Perioperative and short-term outcomes were analyzed.
 Results: Compared with the ILE group, patients underwent MIE-McKeown had less blood loss, less pulmonary infection, longer resection length and more harvested lymph nodes (P<0.05), but they had more anastomotic leakage and stricture rate, longer operation time and hospital stay as well (P<0.05). The total rate of lymph node metastatic in all patients was 52.8%, and the rate of cervical lymph node metastases was 9.5% in the MIE-McKeown group. Multiple carcinomas were found in 16 cases, and 7 were proximally located. The distance from the distal margin of the second lesion to the center of the main lesion was 20-85 (50.7±23.0) mm, while the distance in 9 second carcinomas distally located was 30-90 (57.8±20.5) mm.
 Conclusion: Compared with Ivor-Lewis esophagectomy procedure, MIE-McKeown procedure has a more complete lesion dissection and more harvested lymph nodes with smaller incisions, better short-term outcomes and more safety. It is an appropriate procedure for esophagectomy. However, it should be optimized for its high rate of anastomotic leakage and stricture.

Surgical management of end-stage achalasia.

Esophageal achalasia is a chronic and progressive motility disorder that leads to massive esophageal dilation when left untreated. Treatment for achalasia is palliative and aimed to relieve the outflow obstruction at the level of the lower esophageal sphincter, yet protecting the esophageal mucosa from refluxing gastric acids. The best way to accomplish this goal is through an esophageal myotomy and partial fundoplication, with a success rate >90%. Progression of disease, treatment failure, and complications from gastroesophageal reflux disease cause progressive deterioration of the esophageal function to an end stage in about 5% of patients. The only chance to improve symptoms in this small group of patients is through an esophageal resection. This article will review the indications for esophagectomy in end-stage achalasia, present the different types of surgical approach and possibilities for reconstruction of the alimentary tract, and summarize the short-term and long-term postoperative results.

Preoperative chemoradiotherapy prior to esophagectomy in elderly patients is not associated with increased morbidity.

BACKGROUND: Preoperative chemotherapy and radiation therapy are often administered to patients with esophageal cancer. Despite an aging population, little data exist regarding feasibility of preoperative therapy in elderly patients. METHODS: Between January 1997 and December 2002, 312 consecutive patients underwent esophagectomy for esophageal cancer at our institution. Outcomes of patients 70 years old, who underwent preoperative therapy (n = 35; group II), were compared with those of patients who did not (n = 39; group I) and with those of patients younger than 70 years old who received preoperative therapy (n = 165; group III). RESULTS: The median age was 75 years old for group I and 72 years for group II (p < 0.001). The patients in group II were of more advanced clinical stage (p < 0.001). There were no differences in performance status, comorbidities, or preoperative symptoms between the two groups. Similar proportions of patients in the groups I and II underwent a transhiatal approach (52.5% vs 42.8%, p = not significant [NS]). Perioperative mortality for groups I and II was 0% and 3%, respectively (p = NS). Group II received more perioperative blood transfusions (71.4% vs 48.7%, p = 0.047). There were no differences in the rates of postoperative cardiac, pulmonary, neurologic, gastrointestinal, or anastomotic complications. Compared with group III, group II patients had higher rates of postoperative atrial arrhythmias (p = 0.013) and perioperative blood transfusions (p = 0.004). CONCLUSIONS: Elderly patients receiving preoperative therapy for esophageal cancer do not have an increased incidence of major postoperative complications. Elderly patients receiving preoperative therapy are more likely to develop postoperative atrial arrhythmias and require transfusion than younger patients.

Cáncer de esofago: Tratamiento quirúrgico esofaguectomia transmediatinal o toracotomía

El cáncer de esófago es una de las patologías difíciles de tratar, básicamente por razones que involucran tardanza en el diagnóstico debido a que cuando el paciente presenta los síntomas iniciales como disfagia, el cáncer se encuentra ya en un estadio avanzado, frente a lo cual las alternativas de tratamiento quirúrgico en la gran mayoría son de carácter paliativo, y deben er analizadas correctamente, guiadas a obtener un adecuado tránsito digestivo para de esta manera ayudar a que los pacientes con esta enfermedad tengan una vida digna y puedan llegar hasta sus útlimos días, con la satisfacción de cunmlplir con una de las funciones básicas del ser humano que es el poder comer...