Department of General, Visceral, Transplantation, Vascular, and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
Comprehensive Cancer Centre, Wuerzburg, Germany.
Langenbecks Arch Surg. 2024 Aug 3;409(1):238. doi: 10.1007/s00423-024-03433-6.
Retrosternal oesophageal reconstructions with collar anastomoses can become necessary when the stomach is either unavailable for oesophageal replacement, or orthotopic reconstruction is deemed impractical. Our aim was to analyse our results regarding technical approaches and outcomes.
All patients undergoing primary and secondary oesophageal retrosternal reconstructions with collar anastomoses at our centre (2019-2023) were retrospectively analysed and individual surgical reconstruction options were presented.
Overall, twelve patients received primary (n = 5; 42.7%) or secondary (n = 7; 58.3%) reconstructions; ten with colonic interposition and two with gastric pull-up. Male/female ratio was 4:8; median age 66 years (30-87). Charlson-Comorbidity-Score (CCS) was 5 (1-7); 8/12 patients (67%) had ASA-classification score ≥ 3. We observed no conduit necrosis, but one patient (8.3%) with a leakage of the oesophago-colonostomy which was successfully treated by endoscopic vacuum therapy. Four patients (33.3%) acquired nosocomial pneumonia. Additional drainages for pleural fluid collections were necessary in three patients (25%). Overall comprehensive-complication-index (CCI) was 26.2 (0-44.9). Length-of-stay (LOS) was 22 days median (15-40). There was no 90-days mortality. Overall, CCI during the follow-up (FU) period at median 26 months (16-50) was 33.7 (0-100). 10 out of 12 patients were on sufficient oral nutrition at 12 months FU.
Primary and secondary oesophageal retrosternal reconstructions encompass diverse entities and typically requires tailored decision-making. These procedures, though rare, are feasible with acceptable complication rates and positive functional outcomes when performed in experienced hands.
当胃不可用于食管替代或认为原位重建不切实际时，可能需要进行胸骨后食管重建伴领状吻合。我们的目的是分析我们在技术方法和结果方面的经验。
对 2019 年至 2023 年在我们中心接受原发性和继发性胸骨后食管重建伴领状吻合的所有患者进行回顾性分析，并介绍了个体手术重建选择。
共有 12 名患者接受了原发性（n=5；42.7%）或继发性（n=7；58.3%）重建；10 例采用结肠间置，2 例采用胃上提。男女比例为 4:8；中位年龄 66 岁（30-87 岁）。Charlson 合并症评分（CCS）为 5（1-7）；12 例患者中 8 例（67%）美国麻醉医师协会（ASA）分级评分≥3。我们未观察到移植物坏死，但有 1 例（8.3%）患者发生食管结肠吻合口漏，经内镜真空治疗成功治疗。4 例（33.3%）患者发生医院获得性肺炎。3 例（25%）患者需要引流胸腔积液。总体综合并发症指数（CCI）为 26.2（0-44.9）。中位住院时间（LOS）为 22 天（15-40 天）。无 90 天死亡率。总体而言，中位随访（FU）时间为 26 个月（16-50 个月）时的 CCI 为 33.7（0-100）。12 例患者中有 10 例在 FU 12 个月时进行了充足的口服营养。
原发性和继发性胸骨后食管重建包含多种实体，通常需要量身定制决策。这些手术虽然罕见，但在经验丰富的手中进行时，具有可接受的并发症发生率和积极的功能结果。
