Evaluation of Anastomotic Leak after Esophagectomy for Esophageal Cancer: Typical Time Point of Occurrence, Mode of Diagnosis, Value of Routine Radiocontrast Agent Studies and Therapeutic Options

2017 ◽  
Vol 35 (5) ◽  
pp. 419-426 ◽  
Author(s):  
Benjamin Struecker ◽  
Andreas Andreou ◽  
Sascha Chopra ◽  
Ann-Christin Heilmann ◽  
Johanna Spenke ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leak ◽  
Therapeutic Options ◽  
Radiocontrast Agent ◽  
Occurrence Mode ◽  
Typical Time ◽  
Time Point

Stenosis of the celiac trunk is associated with anastomotic leak after Ivor–Lewis esophagectomy

2019 ◽  
Vol 32 (7) ◽  
Author(s):  
S Brinkmann ◽  
D H Chang ◽  
K Kuhr ◽  
A H Hoelscher ◽  
J Spiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Anastomotic Leak ◽  
Preoperative Staging ◽  
Multivariable Analysis ◽  
Celiac Trunk ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Significant Difference ◽  
Postoperative Anastomotic Leak

SUMMARY Transthoracic esophagectomy with gastric tube formation is the surgical treatment of choice for esophageal cancer. The surgical reconstruction induces changes of gastric microcirculation, which are recognized as potential risk factors of anastomotic leak. This prospective observational study investigates the association of celiac trunk (TC) stenosis with postoperative anastomotic leak. One hundred fifty-four consecutive patients with esophageal cancer scheduled for Ivor–Lewis esophagectomy were included. Preoperative staging computed tomography (CT) was used to identify TC stenosis. Any narrowing of the lumen due to atherosclerotic changes was classified as stenosis. Percentage of stenotic changes was calculated using the North American Symptomatic Carotid Endarterectomy Trial formula. Multivariable analysis was used to identify possible risk factors for leak. The overall incidence of TC stenosis was 40.9%. Anastomotic leak was identified in 15 patients (9.7%). Incidence of anastomotic leak in patients with stenosis was 19.4% compared to 2.3% in patients without stenosis. Incidence of stenosis in patients with leak was 86.7% (13 of 15 patients) and significantly higher than 38.8% (54 of 139 patients) in patients without leak (P < 0.001). There was a significant difference in median degree of TC stenosis (50.0% vs 39.4%; P = 0.032) in patients with and without leak. In the multivariable model, TC stenosis was an independent risk factor for anastomotic leak (odds ratio: 5.98, 95% CI: 1.58–22.61). TC stenosis is associated with postoperative anastomotic leak after Ivor–Lewis esophagectomy. Routine assessment of TC for possible stenosis is recommended to identify patients at risk.

scholarly journals Anastomotic leakage after esophagectomy for esophageal cancer: definitions, diagnostics, and treatment

2020 ◽  
Author(s):  
M Fabbi ◽  
E R C Hagens ◽  
M I van Berge Henegouwen ◽  
S S Gisbertz
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Postoperative Morbidity ◽  
Retrospective Studies ◽  
Recent Literature ◽  
Therapeutic Options ◽  
Treatment And Prevention ◽  
Diagnostic Modalities

Summary Anastomotic leakage is one of the most severe complications after esophagectomy and is associated with increased postoperative morbidity and mortality. Several projects ranging from small retrospective studies to large collaborations have aimed to identify potential pre- and perioperative risk factors and to improve the diagnostic processes and management. Despite the increase in available literature, many aspects of anastomotic leakage are still debated, without the existence of widely accepted guidelines. The purpose of this review is to provide a cutting edge overview of the recent literature regarding the definition and classification of anastomotic leakage, risk factors, novel diagnostic modalities, and emerging therapeutic options for treatment and prevention of anastomotic leakage following esophagectomy.

The impact of cervical anastomotic leak after esophagectomy on long-term survival of patients with esophageal cancer

Surgery ◽  
2021 ◽  
Author(s):  
Vladimir Tverskov ◽  
Ory Wiesel ◽  
Daniel Solomon ◽  
Ran Orgad ◽  
Hanoch Kashtan
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leak ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

Simulation of a Free Surface Flow over a Vertical Weir

2012 ◽  
Vol 256-259 ◽  
pp. 2616-2620
Author(s):  
Y. L. Liu ◽  
Y. Bai
Keyword(s):  
Numerical Simulation ◽  
Free Surface ◽  
Theoretical Analysis ◽  
Flow Field ◽  
Free Surface Flow ◽  
Surface Flow ◽  
Navier Stokes ◽  
Numerical Software ◽  
Typical Time ◽  
Time Point

In this paper the numerical simulation of a free surface flow over a vertical weir with in turns of a scour pool and a small hump weir is presented. Since in this case few of calculative examples adds scour pool and small hump weir in the model, it is meaningful to compute this example using a numerical software which is named Fluent 6.3. The numerical method used consists of Navier–Stokes turbulence solver and k-ε model together with a VOF method and PISO algorithm in pave meshes. Thus, the sketches of flow fields on each typical time point and velocity distributions on each section on 16s are provided to describe flow field accurately. A very good quantitative consequence which accords with hydraulics theoretical analysis has been obtained.

Intrathoracic hand-sewn esophagogastric anastomosis in prone position during totally minimally invasive two-stage esophagectomy for esophageal cancer

2020 ◽  
Author(s):  
Alexandros Charalabopoulos ◽  
Spyridon Davakis ◽  
Athanasios Syllaios ◽  
Bruno Lorenzi
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Prone Position ◽  
Minimally Invasive Esophagectomy ◽  
Esophagogastric Anastomosis ◽  
Two Stage ◽  
End Points ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Summary Utilization of totally minimally invasive esophagectomy for cancer is on the rise. Esophagogastric anastomosis is mechanically or robotically performed routinely; little report exists of hand-sewn esophagogastric anastomosis. This is the largest so far study with thoracoscopic hand-sewn esophagogastric anastomosis during fully minimally invasive two-stage esophagectomy for esophageal cancer in prone position. Consecutive two-stage totally minimally invasive esophagectomies for cancer were performed by one surgical team, from September 2016 to March 2019. All operations were technically identical in terms of patient positioning, surgical approach, extend of lymphadenectomy and type of anastomosis formed. Primary end points were anastomotic leak and anastomotic stricture rate, while secondary end points were 30-day and 90-day mortality rates. From the overall n = 80 patients, n = 67 were males, while n = 13 were females. Mean age was 64.6 years. Mean length of stay was n = 14 days. There were no conversions to open. Mean operating time was 420 minutes with no blood loss over 200 mL noted. Pulmonary and cardiac complication rate was 23.75% and 2.5%, respectively. Anastomotic leak rate was 2.5%. Anastomotic strictures were seen in 12.5% of cases. 30-day and 90-day mortality rate was 2.5% and 5%, respectively, with none accounted for ischemic conduit complications. Intrathoracic anastomosis in totally minimally invasive esophagectomy is challenging and accountable for most of the mortality associated with the procedure. In thoracoscopic two-stage esophagectomy, a mechanical anastomosis is usually preferred; this is believed to be due to the complexity of manual anastomosis associated with the thoracoscopic approach. We aim to present our series of completely hand-sewn intrathoracic anastomosis utilizing a totally minimally invasive approach with favorable outcomes. With this study, reproducibility of the anastomosis is shown that can potentially favor a change in the practice of esophageal surgeons worldwide.

Size of the thoracic inlet predicts cervical anastomotic leak after retrosternal reconstruction after esophagectomy for esophageal cancer

Surgery ◽  
2020 ◽  
Vol 168 (3) ◽  
pp. 558-566
Author(s):  
Shinsuke Sato ◽  
Eiji Nakatani ◽  
Kazuya Higashizono ◽  
Erina Nagai ◽  
Yusuke Taki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leak ◽  
Thoracic Inlet
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