Eichelmann Ann-Kathrin, Nikitina Milana, Bahde Ralf, Mardin Wolf A, Slepecka Patrycja, Kebschull Linus, Senninger Norbert, Pascher Andreas, Palmes Daniel
Department of General, Visceral and Transplant Surgery, University of Muenster, Germany.
Department of Medical Controlling, University Hospital of Muenster, Germany.
Am Surg. 2022 Feb;88(2):194-200. doi: 10.1177/0003134820983185. Epub 2021 Jan 27.
Reconstruction after combined cardia resection and removal of the gastroesophageal junction can be carried out by the Merendino procedure or via a gastric conduit. This study compares postoperative complications and quality of life for both approaches.
All patients who underwent Merendino or gastric conduit reconstruction from 2011-2017 were included. Both groups were investigated regarding postoperative length of stay, complications, and gastrointestinal quality of life.
45 patients were identified, of which, 39 remained for analysis: 22 patients in the Merendino group and 17 patients in the gastric conduit group. The median age of patients in the gastric conduit group (71 (53-92) years) was significantly higher than in the Merendino group (58 (19-75) years), = .0002. Hospital stay was significantly longer in the gastric conduit group (35.9 (11-82) days vs. 18.2 (7-43) days, = .0299) and incidence of anastomotic leakage was higher (24% vs. 9%, = .0171). General incidence of complications (Clavien-Dindo) did not vary ( = .1694). However, grade 5 complications only occurred in the Merendino group (n = 1). Evaluation of long-term outcome and quality of life showed dysphagia to only have occurred in the Merendino group (n = 3, 14%).
Both approaches have advantages and disadvantages: The Merendino procedure showed reduced incidence of anastomotic leakage and shorter hospital stay but was associated with a higher in-hospital mortality rate. Discrepancies in subgroup populations as well as small patient numbers limit the interpretation of the findings. This study does however provide a first comparison of these surgical approaches and may serve as a basis for further investigation.
