Improved anastomotic leakage rates after the "flap and wrap" reconstruction in Ivor Lewis esophagectomy for cancer

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Improved anastomotic leakage rates after the "flap and wrap" reconstruction in Ivor Lewis esophagectomy for cancer. / Slaman, Annelijn E.; Eshuis, Wietse J.; van Berge Henegouwen, Mark I. et al.

In: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, Vol. 36, No. 1, 31.12.2022.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{d1c9e2db6be243f1a4fdbf98a638c37d,

title = "Improved anastomotic leakage rates after the {"}flap and wrap{"} reconstruction in Ivor Lewis esophagectomy for cancer",

abstract = "Anastomotic leakage after esophagectomy has serious consequences. In Ivor Lewis esophagectomy, a shorter and possibly better vascularized gastric conduit is created than in McKeown esophagectomy. Intrathoracic anastomoses can additionally be wrapped in omentum and concealed behind the pleura ({"}flap and wrap{"} reconstruction). Aims of this observational study were to assess the anastomotic leakage incidence after transhiatal esophagectomy (THE), McKeown esophagectomy (McKeown), Ivor Lewis esophagectomy (IL) without {"}flap and wrap{"} reconstruction, and IL with {"}flap and wrap{"} reconstruction. Consecutive patients undergoing esophagectomy at a tertiary referral center between January 2013 and April 2019 were included. Primary outcome was the anastomotic leakage rate. Secondary outcomes were postoperative outcomes, mortality, and 3-year overall survival. A total of 463 patients were included. The anastomotic leakage incidence after THE (n = 37), McKeown (n = 97), IL without {"}flap and wrap{"} reconstruction (n = 39), and IL with {"}flap and wrap{"} reconstruction (n = 290) were 24.3, 32.0, 28.2, and 7.2% (P < 0.001). THE and IL with {"}flap and wrap{"} reconstruction required fewer reoperations for anastomotic leakage (0 and 1.4%) than McKeown and IL without {"}flap and wrap{"} reconstruction (6.2 and 17.9%, P < 0.001). Fewer anastomotic leakages are observed after Ivor Lewis esophagectomy with {"}flap and wrap{"} reconstruction compared to transhiatal, McKeown and Ivor Lewis esophagectomy without {"}flap and wrap{"} reconstruction. The {"}flap and wrap{"} reconstruction seems a promising technique to further reduce anastomotic leakages and its severity in esophageal cancer patients who have an indication for Ivor Lewis esophagectomy.",

keywords = "anastomotic leakage, cancer esophagus, complications, digestive surgery, esophageal cancer, esophagectomy, esophagogastric anastomosis, minimally invasive, surgery, survival",

author = "Slaman, {Annelijn E.} and Eshuis, {Wietse J.} and {van Berge Henegouwen}, {Mark I.} and Gisbertz, {Suzanne S.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.",

year = "2022",

month = dec,

day = "31",

doi = "10.1093/dote/doac036",

language = "English",

volume = "36",

journal = "Diseases of the esophagus",

issn = "1120-8694",

publisher = "Wiley-Blackwell",

number = "1",

}

RIS

TY - JOUR

T1 - Improved anastomotic leakage rates after the "flap and wrap" reconstruction in Ivor Lewis esophagectomy for cancer

AU - Slaman, Annelijn E.

AU - Eshuis, Wietse J.

AU - van Berge Henegouwen, Mark I.

AU - Gisbertz, Suzanne S.

N1 - Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

PY - 2022/12/31

Y1 - 2022/12/31

N2 - Anastomotic leakage after esophagectomy has serious consequences. In Ivor Lewis esophagectomy, a shorter and possibly better vascularized gastric conduit is created than in McKeown esophagectomy. Intrathoracic anastomoses can additionally be wrapped in omentum and concealed behind the pleura ("flap and wrap" reconstruction). Aims of this observational study were to assess the anastomotic leakage incidence after transhiatal esophagectomy (THE), McKeown esophagectomy (McKeown), Ivor Lewis esophagectomy (IL) without "flap and wrap" reconstruction, and IL with "flap and wrap" reconstruction. Consecutive patients undergoing esophagectomy at a tertiary referral center between January 2013 and April 2019 were included. Primary outcome was the anastomotic leakage rate. Secondary outcomes were postoperative outcomes, mortality, and 3-year overall survival. A total of 463 patients were included. The anastomotic leakage incidence after THE (n = 37), McKeown (n = 97), IL without "flap and wrap" reconstruction (n = 39), and IL with "flap and wrap" reconstruction (n = 290) were 24.3, 32.0, 28.2, and 7.2% (P < 0.001). THE and IL with "flap and wrap" reconstruction required fewer reoperations for anastomotic leakage (0 and 1.4%) than McKeown and IL without "flap and wrap" reconstruction (6.2 and 17.9%, P < 0.001). Fewer anastomotic leakages are observed after Ivor Lewis esophagectomy with "flap and wrap" reconstruction compared to transhiatal, McKeown and Ivor Lewis esophagectomy without "flap and wrap" reconstruction. The "flap and wrap" reconstruction seems a promising technique to further reduce anastomotic leakages and its severity in esophageal cancer patients who have an indication for Ivor Lewis esophagectomy.

AB - Anastomotic leakage after esophagectomy has serious consequences. In Ivor Lewis esophagectomy, a shorter and possibly better vascularized gastric conduit is created than in McKeown esophagectomy. Intrathoracic anastomoses can additionally be wrapped in omentum and concealed behind the pleura ("flap and wrap" reconstruction). Aims of this observational study were to assess the anastomotic leakage incidence after transhiatal esophagectomy (THE), McKeown esophagectomy (McKeown), Ivor Lewis esophagectomy (IL) without "flap and wrap" reconstruction, and IL with "flap and wrap" reconstruction. Consecutive patients undergoing esophagectomy at a tertiary referral center between January 2013 and April 2019 were included. Primary outcome was the anastomotic leakage rate. Secondary outcomes were postoperative outcomes, mortality, and 3-year overall survival. A total of 463 patients were included. The anastomotic leakage incidence after THE (n = 37), McKeown (n = 97), IL without "flap and wrap" reconstruction (n = 39), and IL with "flap and wrap" reconstruction (n = 290) were 24.3, 32.0, 28.2, and 7.2% (P < 0.001). THE and IL with "flap and wrap" reconstruction required fewer reoperations for anastomotic leakage (0 and 1.4%) than McKeown and IL without "flap and wrap" reconstruction (6.2 and 17.9%, P < 0.001). Fewer anastomotic leakages are observed after Ivor Lewis esophagectomy with "flap and wrap" reconstruction compared to transhiatal, McKeown and Ivor Lewis esophagectomy without "flap and wrap" reconstruction. The "flap and wrap" reconstruction seems a promising technique to further reduce anastomotic leakages and its severity in esophageal cancer patients who have an indication for Ivor Lewis esophagectomy.

KW - anastomotic leakage

KW - cancer esophagus

KW - complications

KW - digestive surgery

KW - esophageal cancer

KW - esophagectomy

KW - esophagogastric anastomosis

KW - minimally invasive

KW - surgery

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=85145954848&partnerID=8YFLogxK

U2 - 10.1093/dote/doac036

DO - 10.1093/dote/doac036

M3 - Article

C2 - 35724430

VL - 36

JO - Diseases of the esophagus

JF - Diseases of the esophagus

SN - 1120-8694

IS - 1

ER -

ID: 30840253

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