The Comparison Between the Complications after Two Surgical Techniques of Esophageal Cancer

Document Type: Original Article

Authors

1 General Surgeon, Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Thoracic Surgeon, Cardio‐ Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 General Surgeon , Babol University of Medical Sciences, Babol, Iran

4 Pediatric Surgeon, Pediatric Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

5 Resident of Pathology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

6 Community Medicine Specialist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it.
Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group.
Results: In a retrospective cohort study 100 patients entered the study with 59 male & 41 female and with a mean age 54.6±6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique (P=0.182) so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique (P=0.03) so there was a significant difference between the two groups.
Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis.

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