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Revista chilena de cirugía

On-line version ISSN 0718-4026

Abstract

BRAGHETTO M., Italo et al. Outcome and oncological prognosis of esophageal anastomotic fistulas in the treatment of esophageal cancer. Comparative study according to gastric tube ascent. Rev Chil Cir [online]. 2018, vol.70, n.1, pp.19-26. ISSN 0718-4026.  http://dx.doi.org/10.4067/S0718-40262018000100019.

Introduction

Post operative leaks of esophageal anastomosis after esophagectomy is a risky event associated with poor postoperative evolution. Its frequency and severity will depend mainly on surgical technical aspects.

Objectives

To analyze the frequency, management and prognosis of leakage of esophageal anastomosis after esophagectomy for esophageal cancer.

Material and Method

Analysis of our prospective oncologic database of patients with esophageal cancers submmitted to esofagectomy. Statistical analysis with Fisher's exact test.

Results

34 out of 37 esophageal cancer patients were included submitted to completely invasive mini esophagectomy. Cervical anastomosis was performed in 79.4% of patients, in the remaining 20.6%, a distal esophagectomy with intrathoracic anastomosis was performed. The leak rate was 38.2% (13/34), of these, 69.2% (9/13) correspond to grade Clavien - Dindo I - II complications. The leak rate was 54.5% (6/11) for retro-sternal gastric ascensus and 43.7% (7/16) for mediastinal route, without significative difference (p = 1.0). The reoperation rate was 11.7%, being a 100% secondary to mediastinal ascensus, 3 of them were submitted to thoracoscopic toilets and an innominate vein repair. Postoperative mortality rate was 5.8%, all concentrated in the group of patients with posterior mediastinal ascensus, but without statistical difference (p = 0.26).

Conclusion

Leaks are frequent in patients operated on for esophageal cancer, especially after cervical esophago-gastro-anastomosis with anterior route for ascensus. However, retro-sternal ascensus did not require re-operations, nor postoperative mortality compared to gastric ascensus through posterior mediastinum

Keywords : Esophageal cancer; Esophagectomy; Anastomotic leaks.

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