Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy
Background The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests...
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| Veröffentlicht in: | Journal of surgical oncology 2021-09, Vol.124 (4), p.529-539 |
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| container_title | Journal of surgical oncology |
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| creator | Housman, Brian Lee, Dong‐Seok Wolf, Andrea Nicastri, Daniel Kaufman, Andrew Rizk, Nabil Housman, Arno Song, Kimberly Hakami, Ardeshir Flores, Raja M. |
| description | Background
The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests that the procedure itself may have inherent limitations including the use of potentially ischemic tissue for the esophagogastric anastomosis. We introduce a modified technique that reduces operative steps, preserves blood supply, and uses a modified esophagogastric anastomosis.
Methods
All consecutive patients undergoing ILE with the described modified technique were identified. An esophagram was performed on postoperative day six or seven. To ensure that all cases were identified, anastomotic leaks were defined as any radiographic evidence of contrast extravasation.
Results
A total of 110 patients underwent the modified esophagectomy with 2 anastomotic leaks (1.82%) and zero strictures. There was 1 late death but no early deaths ( |
| doi_str_mv | 10.1002/jso.26550 |
| format | Article |
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The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests that the procedure itself may have inherent limitations including the use of potentially ischemic tissue for the esophagogastric anastomosis. We introduce a modified technique that reduces operative steps, preserves blood supply, and uses a modified esophagogastric anastomosis.
Methods
All consecutive patients undergoing ILE with the described modified technique were identified. An esophagram was performed on postoperative day six or seven. To ensure that all cases were identified, anastomotic leaks were defined as any radiographic evidence of contrast extravasation.
Results
A total of 110 patients underwent the modified esophagectomy with 2 anastomotic leaks (1.82%) and zero strictures. There was 1 late death but no early deaths (<30 or 90 days) or early re‐admissions (<30 days). The average number of risk factors was 2.12, and 98 patients (90%) had at least 1 risk factor in their medical history.
Conclusions
The modifications proposed simplify procedural steps, limit unnecessary dissection and introduce a technique that ends the practice of connecting ischemic tissue. We believe this technique contributes to surgical durability and reduces the rate of postoperative leak and eliminates stricture.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.26550</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc</publisher><subject>anastomosis ; esophagectomy ; Esophagus ; Ivor Lewis</subject><ispartof>Journal of surgical oncology, 2021-09, Vol.124 (4), p.529-539</ispartof><rights>2021 Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3300-d97d559ae94f7e5f3a29a06b5797c38245e95f263ab38c652cac2c2ce9004fde3</citedby><cites>FETCH-LOGICAL-c3300-d97d559ae94f7e5f3a29a06b5797c38245e95f263ab38c652cac2c2ce9004fde3</cites><orcidid>0000-0001-7718-7422</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjso.26550$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjso.26550$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids></links><search><creatorcontrib>Housman, Brian</creatorcontrib><creatorcontrib>Lee, Dong‐Seok</creatorcontrib><creatorcontrib>Wolf, Andrea</creatorcontrib><creatorcontrib>Nicastri, Daniel</creatorcontrib><creatorcontrib>Kaufman, Andrew</creatorcontrib><creatorcontrib>Rizk, Nabil</creatorcontrib><creatorcontrib>Housman, Arno</creatorcontrib><creatorcontrib>Song, Kimberly</creatorcontrib><creatorcontrib>Hakami, Ardeshir</creatorcontrib><creatorcontrib>Flores, Raja M.</creatorcontrib><title>Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy</title><title>Journal of surgical oncology</title><description>Background
The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests that the procedure itself may have inherent limitations including the use of potentially ischemic tissue for the esophagogastric anastomosis. We introduce a modified technique that reduces operative steps, preserves blood supply, and uses a modified esophagogastric anastomosis.
Methods
All consecutive patients undergoing ILE with the described modified technique were identified. An esophagram was performed on postoperative day six or seven. To ensure that all cases were identified, anastomotic leaks were defined as any radiographic evidence of contrast extravasation.
Results
A total of 110 patients underwent the modified esophagectomy with 2 anastomotic leaks (1.82%) and zero strictures. There was 1 late death but no early deaths (<30 or 90 days) or early re‐admissions (<30 days). The average number of risk factors was 2.12, and 98 patients (90%) had at least 1 risk factor in their medical history.
Conclusions
The modifications proposed simplify procedural steps, limit unnecessary dissection and introduce a technique that ends the practice of connecting ischemic tissue. We believe this technique contributes to surgical durability and reduces the rate of postoperative leak and eliminates stricture.</description><subject>anastomosis</subject><subject>esophagectomy</subject><subject>Esophagus</subject><subject>Ivor Lewis</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp10c2O0zAQB3ALLRLdwoE3sLQXOKSd2HESH1cVH7vqag_AOZo6k9YhiYudblVOiCfgGXkSvA1wQEI-jGT_ZjzSn7GXKSxSALFsg1uIXCl4wmYp6DzRoMsLNotvIskKDc_YZQgtAGidZzP2_Q5b53nvattYg6N1Q-Cj470dbG-_Eh93zqOxhlNw-x1u3c9vP7YYRh-vOsLPHIeak8f6sZv-KMKOn8148MSxGcnzm4f40ZqONvxVZnT96Tl72mAX6MXvOmef3r75uHqfrO_f3ayu14mREiCpdVErpZF01hSkGolCI-QbVejCyFJkirRqRC5xI0uTK2HQiHhIA2RNTXLOXk1z9959OVAYq94GQ12HA7lDqISSeQmpSkWkV__Q1h38ELeLSpVxH6llVK8nZbwLwVNT7b3t0Z-qFKrHNKqYRnVOI9rlZI-2o9P_YXX74X7q-AVZvo81</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Housman, Brian</creator><creator>Lee, Dong‐Seok</creator><creator>Wolf, Andrea</creator><creator>Nicastri, Daniel</creator><creator>Kaufman, Andrew</creator><creator>Rizk, Nabil</creator><creator>Housman, Arno</creator><creator>Song, Kimberly</creator><creator>Hakami, Ardeshir</creator><creator>Flores, Raja M.</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7718-7422</orcidid></search><sort><creationdate>20210901</creationdate><title>Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy</title><author>Housman, Brian ; Lee, Dong‐Seok ; Wolf, Andrea ; Nicastri, Daniel ; Kaufman, Andrew ; Rizk, Nabil ; Housman, Arno ; Song, Kimberly ; Hakami, Ardeshir ; Flores, Raja M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3300-d97d559ae94f7e5f3a29a06b5797c38245e95f263ab38c652cac2c2ce9004fde3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>anastomosis</topic><topic>esophagectomy</topic><topic>Esophagus</topic><topic>Ivor Lewis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Housman, Brian</creatorcontrib><creatorcontrib>Lee, Dong‐Seok</creatorcontrib><creatorcontrib>Wolf, Andrea</creatorcontrib><creatorcontrib>Nicastri, Daniel</creatorcontrib><creatorcontrib>Kaufman, Andrew</creatorcontrib><creatorcontrib>Rizk, Nabil</creatorcontrib><creatorcontrib>Housman, Arno</creatorcontrib><creatorcontrib>Song, Kimberly</creatorcontrib><creatorcontrib>Hakami, Ardeshir</creatorcontrib><creatorcontrib>Flores, Raja M.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Housman, Brian</au><au>Lee, Dong‐Seok</au><au>Wolf, Andrea</au><au>Nicastri, Daniel</au><au>Kaufman, Andrew</au><au>Rizk, Nabil</au><au>Housman, Arno</au><au>Song, Kimberly</au><au>Hakami, Ardeshir</au><au>Flores, Raja M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy</atitle><jtitle>Journal of surgical oncology</jtitle><date>2021-09-01</date><risdate>2021</risdate><volume>124</volume><issue>4</issue><spage>529</spage><epage>539</epage><pages>529-539</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>Background
The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests that the procedure itself may have inherent limitations including the use of potentially ischemic tissue for the esophagogastric anastomosis. We introduce a modified technique that reduces operative steps, preserves blood supply, and uses a modified esophagogastric anastomosis.
Methods
All consecutive patients undergoing ILE with the described modified technique were identified. An esophagram was performed on postoperative day six or seven. To ensure that all cases were identified, anastomotic leaks were defined as any radiographic evidence of contrast extravasation.
Results
A total of 110 patients underwent the modified esophagectomy with 2 anastomotic leaks (1.82%) and zero strictures. There was 1 late death but no early deaths (<30 or 90 days) or early re‐admissions (<30 days). The average number of risk factors was 2.12, and 98 patients (90%) had at least 1 risk factor in their medical history.
Conclusions
The modifications proposed simplify procedural steps, limit unnecessary dissection and introduce a technique that ends the practice of connecting ischemic tissue. We believe this technique contributes to surgical durability and reduces the rate of postoperative leak and eliminates stricture.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/jso.26550</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7718-7422</orcidid></addata></record> |
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| subjects | anastomosis esophagectomy Esophagus Ivor Lewis |
| title | Major modifications to minimize thoracic esophago‐gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy |
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