Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Dis Esophagus. 2022 Dec 14;35(12). doi: 10.1093/dote/doac033.
Despite decreasing overall morbidity with minimally invasive esophagectomy (MIE), conduit functional outcomes related to delayed emptying remain challenging, especially in the immediate postoperative setting. Yet, this problem has not been described well in the literature. Utilizing a single institutional prospective database, 254 patients who underwent MIEs between 2012 and 2020 were identified. Gastric conduit dilation was defined as a conduit occupying >40% of the hemithorax on the postoperative chest X-ray. Sixty-seven patients (26.4%) demonstrated acute conduit dilation. There was a higher incidence of conduit dilation in the patients who underwent Ivor Lewis esophagectomy compared to those with a neck anastomosis (67.2% vs. 47.1%; P = 0.03). Patients with dilated conduits required more esophagogastroduodenoscopies (EGD) (P < 0.001), conduit-related reoperations within 180 days (P < 0.001), and 90-day readmissions (P = 0.01). Furthermore, in 37 patients (25.5%) undergoing Ivor Lewis esophagectomy, we returned to the abdomen after intrathoracic anastomosis to reduce redundant conduit and pexy the conduit to the crura. While conduit dilation rates were similar, those who had intraabdominal gastropexy required EGD significantly less and trended toward a lower incidence of conduit-related reoperations (5.6% vs. 2.7%). Multivariable analysis also demonstrated that conduit dilation was an independent predictor for delayed gastric conduit emptying symptoms, EGD within 90 days, conduit-related reoperation within 180 days, and 30-day as well as 90-day readmission. Patients undergoing MIE with acute gastric conduit dilation require more endoscopic interventions and reoperations.
尽管微创食管切除术（MIE）总体上降低了发病率，但与排空延迟相关的管道功能结果仍然具有挑战性，尤其是在术后即刻。然而，这一问题在文献中尚未得到很好的描述。利用一个单一机构的前瞻性数据库，确定了 2012 年至 2020 年间接受 MIE 的 254 名患者。术后胸部 X 线片上胃管扩张定义为管腔占据半胸的>40%。67 例（26.4%）患者表现出急性管腔扩张。与颈部吻合术相比，行 Ivor Lewis 食管切除术的患者发生管腔扩张的发生率更高（67.2% vs. 47.1%；P=0.03）。扩张管腔的患者需要更多的食管胃十二指肠镜检查（EGD）（P<0.001）、180 天内与管腔相关的再次手术（P<0.001）和 90 天内再入院（P=0.01）。此外，在 37 例（25.5%）行 Ivor Lewis 食管切除术的患者中，我们在胸腔内吻合后返回腹部，以减少多余的管腔并将管腔固定到胸肋。尽管管腔扩张率相似，但那些接受腹部胃固定术的患者 EGD 明显减少，并且与管腔相关的再次手术发生率较低（5.6% vs. 2.7%）。多变量分析还表明，管腔扩张是延迟胃管排空症状、90 天内 EGD、180 天内与管腔相关的再次手术以及 30 天和 90 天再入院的独立预测因素。接受 MIE 且发生急性胃管扩张的患者需要更多的内镜干预和再次手术。
