Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France.
Université Paris Descartes, Paris, France.
Br J Surg. 2017 Sep;104(10):1346-1354. doi: 10.1002/bjs.10558. Epub 2017 May 11.
Oesophageal conduit necrosis following oesophagectomy is a rare but life-threatening complication. The present study aimed to assess the impact of coeliac axis stenosis on outcomes after oesophagectomy for cancer.
The study included consecutive patients who had an Ivor Lewis procedure with curative intent for middle- and lower-third oesophageal cancer at two tertiary referral centres. All patients underwent preoperative multidetector CT with arterial phase to detect coeliac axis stenosis. The coeliac artery was classified as normal, with extrinsic stenosis due to a median arcuate ligament or with intrinsic stenosis caused by atherosclerosis.
Some 481 patients underwent an Ivor Lewis procedure. Of these, ten (2·1 per cent) developed oesophageal conduit necrosis after surgery. Coeliac artery evaluation revealed a completely normal artery in 431 patients (91·5 per cent) in the group without conduit necrosis and in one (10 per cent) with necrosis (P < 0·001). Extrinsic stenosis of the coeliac artery due to a median arcuate ligament was found in two patients (0·4 per cent) without conduit necrosis and five (50 per cent) with necrosis (P < 0·001). Intrinsic stenosis of the coeliac artery was found in 11 (2·3 per cent) and eight (80 per cent) patients respectively (P < 0·001). Eight patients without (1·7 per cent) and five (50 per cent) with conduit necrosis had a single and thin left gastric artery (P < 0·001).
This study suggests that oesophageal conduit necrosis after oesophagectomy for cancer may be due to pre-existing coeliac axis stenosis.
食管导管坏死是食管切除术后一种罕见但危及生命的并发症。本研究旨在评估腹腔动脉狭窄对中下段食管癌行 Ivor Lewis 手术的治疗效果的影响。
本研究纳入了在两个三级转诊中心接受 Ivor Lewis 根治性手术治疗中下段食管癌的连续患者。所有患者均在术前进行多排螺旋 CT 动脉期检查，以检测腹腔动脉狭窄。将腹腔动脉分为正常、因正中弓状韧带引起的外源性狭窄和因动脉粥样硬化引起的内源性狭窄。
481 例患者接受了 Ivor Lewis 手术。其中 10 例（2.1%）术后发生食管导管坏死。在无导管坏死组中，431 例（91.5%）患者的腹腔动脉评估完全正常，而在有导管坏死组中仅 1 例（10%）正常（P<0.001）。无导管坏死组中有 2 例（0.4%）因正中弓状韧带引起的外源性狭窄，而有导管坏死组中有 5 例（50%）狭窄（P<0.001）。无导管坏死组中有 11 例（2.3%）和 8 例（80%）患者存在腹腔动脉内源性狭窄（P<0.001）。无导管坏死组中有 8 例（1.7%）和有导管坏死组中有 5 例（50%）患者存在单一且细的左胃动脉（P<0.001）。
本研究表明，食管癌切除术后食管导管坏死可能与术前存在的腹腔动脉狭窄有关。
