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Anastomotic stricture after Ivor Lewis esophagectomy: An evaluation of incidence, risk factors, and treatment

Lookup NU author(s): Josh Brown, Jakub Chmelo, Alexander Phillips

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Abstract

© 2021Background: Anastomotic stricture is a recognized complication after esophagectomy. It can impact the patient's quality of life and may require recurrent dilatations. Thus, the aim of this study was to evaluate the frequency of strictures, contributing factors, and long-term outcomes of management in patients undergoing esophagectomy with thoracic anastomosis using a standardized circular stapled technique. Methods: All patients who underwent a 2-stage transthoracic esophagectomy with curative intent between January 2010 and December 2019 at NOGU, Newcastle upon Tyne, UK were included. All patients who underwent a stapled (circular) intrathoracic anastomosis using gastric conduits were included. Stricture incidence, number of dilatations to resolve strictures, and refractory stricture rate were recorded. Results: Overall, 705 patients were included with 192 (27.2%) developing strictures. Refractory strictures occurred in 38 patients (5.4%). One, 2, and 3 dilatations were needed for resolution of symptoms in 46 (37.4%), 23 (18.7%), and 20 (16.3%) patients, respectively. Multivariable analysis identified the occurrence of an anastomotic leak (odds ratio 1.906, 95% confidence interval 1.088–3.341, P =.024) and circular staple size <28 mm (odds ratio 1.462, 95% confidence interval 1.033–2.070, P =.032) as independent predictors of stricture occurrence. Patients with anastomotic leaks were more likely to develop refractory strictures (13.1% vs 4.7%, odds ratio 3.089, 95% confidence interval 1.349–7.077, P =.008). Conclusion: This study highlights that nearly 30% of patients having a circular stapled anastomosis will require dilatation after surgery. Although the majority will completely resolve after 2 dilatations, 5% will have longer-term problems with refractory strictures.


Publication metadata

Author(s): Koshy RM, Brown JM, Chmelo J, Watkinson T, Phillips AW

Publication type: Article

Publication status: Published

Journal: Surgery

Year: 2021

Pages: epub ahead of print

Online publication date: 03/09/2021

Acceptance date: 20/07/2021

ISSN (print): 0039-6060

ISSN (electronic): 1532-7361

Publisher: Mosby Inc.

URL: https://doi.org/10.1016/j.surg.2021.07.034

DOI: 10.1016/j.surg.2021.07.034


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