538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER

538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER

Abstract Background For upper thoracic esophageal cancer, esophagectomy combined with cervical esophagogastrostomy (cervical anastomosis, CA) and three-field lymph node dissection (3FLND) has been proposed as the standard surgical approach. However, while CA provides sufficient length of proximal re...

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Veröffentlicht in:Diseases of the esophagus 2024-09, Vol.37 (Supplement_1)
Hauptverfasser: Son, Jeonga, Lee, Genehee, Lee, Junghee, Jeon, Yeong Jeong, Park, Seong-Yong, Cho, Jong Ho, Choi, Yong Soo, Kim, Jingook, Kim, Hong Kwan, Shim, Young Mog
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container_issue Supplement_1
container_start_page
container_title Diseases of the esophagus
container_volume 37
creator Son, Jeonga
Lee, Genehee
Lee, Junghee
Jeon, Yeong Jeong
Park, Seong-Yong
Cho, Jong Ho
Choi, Yong Soo
Kim, Jingook
Kim, Hong Kwan
Shim, Young Mog
description Abstract Background For upper thoracic esophageal cancer, esophagectomy combined with cervical esophagogastrostomy (cervical anastomosis, CA) and three-field lymph node dissection (3FLND) has been proposed as the standard surgical approach. However, while CA provides sufficient length of proximal resection margins, it is associated with a higher incidence of postoperative complications such as anastomotic leaks, recurrent laryngeal nerve (RLN) injury, and increased mortality. As an alternative, high-intrathoracic esophagogastric anastomosis (high-ITA) with 3FLND has been performed. We aimed to evaluate the benefits and limitations of high-ITA compared to conventional CA in terms of early postoperative outcomes. Methods A total of 232 patients, who underwent curative esophagogastrostomy with 3FLND and either of high-intrathoracic anastomosis (high-ITA) or cervical anastomosis (CA) for upper thoracic esophageal cancer a tertiary hospital from January 2010 to December 2021. Collected data from medical records were analyzed retrospectively regarding morbidity and mortality rates. The primary end point was recurrence. Anastomotic leak, RLN palsy, hospital stay, and 90-day mortality and in-hospital mortality were evaluated using Chi-squared test, Fisher’s exact test, and T-test. The risk of mortality and recurrence were analyzed using Cox-proportional hazard regression with a median follow-up of 39.1(IQR 17.8, 80.2) months. Results Among the fifty patients with high-ITA and 182 patients with CA, the high-ITA group reported fewer anastomotic leaks (6.0% vs. 19.8%, p=0.02) and a shorter hospital stay (median 12days vs. 15 days, p
doi_str_mv 10.1093/dote/doae057.268
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COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER</title><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Son, Jeonga ; Lee, Genehee ; Lee, Junghee ; Jeon, Yeong Jeong ; Park, Seong-Yong ; Cho, Jong Ho ; Choi, Yong Soo ; Kim, Jingook ; Kim, Hong Kwan ; Shim, Young Mog</creator><creatorcontrib>Son, Jeonga ; Lee, Genehee ; Lee, Junghee ; Jeon, Yeong Jeong ; Park, Seong-Yong ; Cho, Jong Ho ; Choi, Yong Soo ; Kim, Jingook ; Kim, Hong Kwan ; Shim, Young Mog</creatorcontrib><description>Abstract Background For upper thoracic esophageal cancer, esophagectomy combined with cervical esophagogastrostomy (cervical anastomosis, CA) and three-field lymph node dissection (3FLND) has been proposed as the standard surgical approach. However, while CA provides sufficient length of proximal resection margins, it is associated with a higher incidence of postoperative complications such as anastomotic leaks, recurrent laryngeal nerve (RLN) injury, and increased mortality. As an alternative, high-intrathoracic esophagogastric anastomosis (high-ITA) with 3FLND has been performed. We aimed to evaluate the benefits and limitations of high-ITA compared to conventional CA in terms of early postoperative outcomes. Methods A total of 232 patients, who underwent curative esophagogastrostomy with 3FLND and either of high-intrathoracic anastomosis (high-ITA) or cervical anastomosis (CA) for upper thoracic esophageal cancer a tertiary hospital from January 2010 to December 2021. Collected data from medical records were analyzed retrospectively regarding morbidity and mortality rates. The primary end point was recurrence. Anastomotic leak, RLN palsy, hospital stay, and 90-day mortality and in-hospital mortality were evaluated using Chi-squared test, Fisher’s exact test, and T-test. The risk of mortality and recurrence were analyzed using Cox-proportional hazard regression with a median follow-up of 39.1(IQR 17.8, 80.2) months. Results Among the fifty patients with high-ITA and 182 patients with CA, the high-ITA group reported fewer anastomotic leaks (6.0% vs. 19.8%, p=0.02) and a shorter hospital stay (median 12days vs. 15 days, p&lt;0.001). No significant difference was observed in RLN palsy (6.0% vs. 13.7%, p=0.22) and the 90-day or in-hospital mortality rate (2.0% vs. 2.2%, p=1.0). The number of lymph nodes dissected (LND) was similar between the groups (47.4(±15.4) vs. 52.7(±18.3), p=0.06), and there was no difference in the risk of mortality and recurrence according to the high-ITA method (HR 0.9, 95% CI 0.6-1.6; HR 1.0, 95% CI 0.6-1.7) after adjustment for age, sex, and stage. Conclusion In the esophagogastrostomy with three-field lymph node dissection, performing high-intrathoracic anastomosis may reduce the incidence of anastomotic leaks and shorten the hospital stay without adversely affecting overall survival.</description><identifier>ISSN: 1120-8694</identifier><identifier>EISSN: 1442-2050</identifier><identifier>DOI: 10.1093/dote/doae057.268</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>Diseases of the esophagus, 2024-09, Vol.37 (Supplement_1)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Son, Jeonga</creatorcontrib><creatorcontrib>Lee, Genehee</creatorcontrib><creatorcontrib>Lee, Junghee</creatorcontrib><creatorcontrib>Jeon, Yeong Jeong</creatorcontrib><creatorcontrib>Park, Seong-Yong</creatorcontrib><creatorcontrib>Cho, Jong Ho</creatorcontrib><creatorcontrib>Choi, Yong Soo</creatorcontrib><creatorcontrib>Kim, Jingook</creatorcontrib><creatorcontrib>Kim, Hong Kwan</creatorcontrib><creatorcontrib>Shim, Young Mog</creatorcontrib><title>538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER</title><title>Diseases of the esophagus</title><description>Abstract Background For upper thoracic esophageal cancer, esophagectomy combined with cervical esophagogastrostomy (cervical anastomosis, CA) and three-field lymph node dissection (3FLND) has been proposed as the standard surgical approach. However, while CA provides sufficient length of proximal resection margins, it is associated with a higher incidence of postoperative complications such as anastomotic leaks, recurrent laryngeal nerve (RLN) injury, and increased mortality. As an alternative, high-intrathoracic esophagogastric anastomosis (high-ITA) with 3FLND has been performed. We aimed to evaluate the benefits and limitations of high-ITA compared to conventional CA in terms of early postoperative outcomes. Methods A total of 232 patients, who underwent curative esophagogastrostomy with 3FLND and either of high-intrathoracic anastomosis (high-ITA) or cervical anastomosis (CA) for upper thoracic esophageal cancer a tertiary hospital from January 2010 to December 2021. Collected data from medical records were analyzed retrospectively regarding morbidity and mortality rates. The primary end point was recurrence. Anastomotic leak, RLN palsy, hospital stay, and 90-day mortality and in-hospital mortality were evaluated using Chi-squared test, Fisher’s exact test, and T-test. The risk of mortality and recurrence were analyzed using Cox-proportional hazard regression with a median follow-up of 39.1(IQR 17.8, 80.2) months. Results Among the fifty patients with high-ITA and 182 patients with CA, the high-ITA group reported fewer anastomotic leaks (6.0% vs. 19.8%, p=0.02) and a shorter hospital stay (median 12days vs. 15 days, p&lt;0.001). No significant difference was observed in RLN palsy (6.0% vs. 13.7%, p=0.22) and the 90-day or in-hospital mortality rate (2.0% vs. 2.2%, p=1.0). The number of lymph nodes dissected (LND) was similar between the groups (47.4(±15.4) vs. 52.7(±18.3), p=0.06), and there was no difference in the risk of mortality and recurrence according to the high-ITA method (HR 0.9, 95% CI 0.6-1.6; HR 1.0, 95% CI 0.6-1.7) after adjustment for age, sex, and stage. Conclusion In the esophagogastrostomy with three-field lymph node dissection, performing high-intrathoracic anastomosis may reduce the incidence of anastomotic leaks and shorten the hospital stay without adversely affecting overall survival.</description><issn>1120-8694</issn><issn>1442-2050</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqFkMFLwzAUxoMoOKd3j7lL50vapskxlKwNbE1ps4mnsrUpKMpGqwf_Gf9WUzYET17ee_B-3_ceH0L3BBYERPjYHT6cLzsHcbKgjF-gGYkiGlCI4dLPhELAmYiu0c04vgKQJGR8hr7jkC9watalrHRtCmyWWMlq9YxLU1tTqkpavVXYbKyHVD3tU1VtdSpXWBbSM2tT6xpbg3Od5VgX1ktyU8lUp38IuTZFhkvvpwpb4ydtc7wp_QX8i6valLnMlPdOZeHv3KKrfvc2urtzn6PNUtk0D1Ymm14IWkIEDxIWOdf2e9cDdS3fR33sQLTcUcLFPulYCL472jsSMcE4g06EhMaEd-Citg3nCE6-7XAYx8H1zXF4ed8NXw2BZsq3mfJtzvk2Pl8veThJDp_H_-kfIbdzDQ</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Son, Jeonga</creator><creator>Lee, Genehee</creator><creator>Lee, Junghee</creator><creator>Jeon, Yeong Jeong</creator><creator>Park, Seong-Yong</creator><creator>Cho, Jong Ho</creator><creator>Choi, Yong Soo</creator><creator>Kim, Jingook</creator><creator>Kim, Hong Kwan</creator><creator>Shim, Young Mog</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20240901</creationdate><title>538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER</title><author>Son, Jeonga ; Lee, Genehee ; Lee, Junghee ; Jeon, Yeong Jeong ; Park, Seong-Yong ; Cho, Jong Ho ; Choi, Yong Soo ; Kim, Jingook ; Kim, Hong Kwan ; Shim, Young Mog</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1198-764eecfbef02ec8b4f5e09c8e2189b7d63089be2fe14696860d9312518d0e4cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Son, Jeonga</creatorcontrib><creatorcontrib>Lee, Genehee</creatorcontrib><creatorcontrib>Lee, Junghee</creatorcontrib><creatorcontrib>Jeon, Yeong Jeong</creatorcontrib><creatorcontrib>Park, Seong-Yong</creatorcontrib><creatorcontrib>Cho, Jong Ho</creatorcontrib><creatorcontrib>Choi, Yong Soo</creatorcontrib><creatorcontrib>Kim, Jingook</creatorcontrib><creatorcontrib>Kim, Hong Kwan</creatorcontrib><creatorcontrib>Shim, Young Mog</creatorcontrib><collection>CrossRef</collection><jtitle>Diseases of the esophagus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Son, Jeonga</au><au>Lee, Genehee</au><au>Lee, Junghee</au><au>Jeon, Yeong Jeong</au><au>Park, Seong-Yong</au><au>Cho, Jong Ho</au><au>Choi, Yong Soo</au><au>Kim, Jingook</au><au>Kim, Hong Kwan</au><au>Shim, Young Mog</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER</atitle><jtitle>Diseases of the esophagus</jtitle><date>2024-09-01</date><risdate>2024</risdate><volume>37</volume><issue>Supplement_1</issue><issn>1120-8694</issn><eissn>1442-2050</eissn><abstract>Abstract Background For upper thoracic esophageal cancer, esophagectomy combined with cervical esophagogastrostomy (cervical anastomosis, CA) and three-field lymph node dissection (3FLND) has been proposed as the standard surgical approach. However, while CA provides sufficient length of proximal resection margins, it is associated with a higher incidence of postoperative complications such as anastomotic leaks, recurrent laryngeal nerve (RLN) injury, and increased mortality. As an alternative, high-intrathoracic esophagogastric anastomosis (high-ITA) with 3FLND has been performed. We aimed to evaluate the benefits and limitations of high-ITA compared to conventional CA in terms of early postoperative outcomes. Methods A total of 232 patients, who underwent curative esophagogastrostomy with 3FLND and either of high-intrathoracic anastomosis (high-ITA) or cervical anastomosis (CA) for upper thoracic esophageal cancer a tertiary hospital from January 2010 to December 2021. Collected data from medical records were analyzed retrospectively regarding morbidity and mortality rates. The primary end point was recurrence. Anastomotic leak, RLN palsy, hospital stay, and 90-day mortality and in-hospital mortality were evaluated using Chi-squared test, Fisher’s exact test, and T-test. The risk of mortality and recurrence were analyzed using Cox-proportional hazard regression with a median follow-up of 39.1(IQR 17.8, 80.2) months. Results Among the fifty patients with high-ITA and 182 patients with CA, the high-ITA group reported fewer anastomotic leaks (6.0% vs. 19.8%, p=0.02) and a shorter hospital stay (median 12days vs. 15 days, p&lt;0.001). No significant difference was observed in RLN palsy (6.0% vs. 13.7%, p=0.22) and the 90-day or in-hospital mortality rate (2.0% vs. 2.2%, p=1.0). The number of lymph nodes dissected (LND) was similar between the groups (47.4(±15.4) vs. 52.7(±18.3), p=0.06), and there was no difference in the risk of mortality and recurrence according to the high-ITA method (HR 0.9, 95% CI 0.6-1.6; HR 1.0, 95% CI 0.6-1.7) after adjustment for age, sex, and stage. Conclusion In the esophagogastrostomy with three-field lymph node dissection, performing high-intrathoracic anastomosis may reduce the incidence of anastomotic leaks and shorten the hospital stay without adversely affecting overall survival.</abstract><pub>Oxford University Press</pub><doi>10.1093/dote/doae057.268</doi><oa>free_for_read</oa></addata></record>
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title 538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER
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