A non-randomized retrospective observational study on the subcutaneous esophageal reconstruction after esophagectomy: Is it feasible in high-risk patients?

Jae Ho Chung, Sung Ho Lee, Eunjue Yi, Jae-Seung Jung, Jung Wook Han, Tae Sik Kim, Ho Sung Son, Kwang Taik Kim

Research output: Contribution to journalArticle

Abstract

Background: Esophageal reconstruction after esophagectomy is a complex procedure with high morbidity and mortality. Anastomotic leakage is more severe and frequent in patients with preoperative comorbidities and may present with septic conditions. Considering the possibility of an easier management of such cases, we evaluated the safety and feasibility of subcutaneous esophageal reconstruction in patients with high operative risks. Methods: We performed a non-randomized retrospective observational study on the 75 (subcutaneous: 21, intrathoracic: 54) esophageal cancer patients who underwent esophageal reconstruction either through subcutaneous or intrathoracic route between January 2003 and February 2015. Preoperative data including the estimated reasons for the selection of the subcutaneous route were obtained from medical charts. Clinical outcomes were evaluated and compared between the two groups. Results: The mean postoperative hospital stay was longer in the subcutaneous group than the overall group. Anastomotic leakage occurred more frequently in the subcutaneous group [10 (47.6%) vs. 7 (13%), P=0.004]. Three major leakages resulted in chronic cutaneous fistula, but were successfully treated by lower neck reconstruction using radial forearm fasciocutaneous free flap (RFFF). There was no in-hospital mortality in the subcutaneous group. Conclusions: Subcutaneous esophageal reconstruction in high-risk patients showed a higher rate of anastomotic leakage. However, easier correction without fatal septic conditions could be obtained by primary repair or flap reconstruction resulting in lower perioperative mortality. Therefore, esophageal reconstruction through the subcutaneous route is not recommended as a routine primary option. However, in highly selected patients with unfavorable preoperative comorbidities or intraoperative findings, especially those with poor blood supply to the graft, graft hematoma or edema, or gross tumor invasion to surrounding tissues, esophageal reconstruction through the subcutaneous route may carefully be considered as an alternative to the conventional surgical techniques.

Original languageEnglish
Pages (from-to)675-684
Number of pages10
JournalJournal of Thoracic Disease
Volume9
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

Fingerprint

Esophagectomy
Observational Studies
Retrospective Studies
Anastomotic Leak
Comorbidity
Cutaneous Fistula
Transplants
Mortality
Free Tissue Flaps
Case Management
Esophageal Neoplasms
Hospital Mortality
Forearm
Hematoma
Length of Stay
Edema
Neck
Morbidity
Safety
Neoplasms

Keywords

  • Anastomotic leakage
  • Comorbidities
  • Esophageal reconstruction
  • Subcutaneous route

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{06b85f6ee1894b36aab8508d7d28d6c9,
title = "A non-randomized retrospective observational study on the subcutaneous esophageal reconstruction after esophagectomy: Is it feasible in high-risk patients?",
abstract = "Background: Esophageal reconstruction after esophagectomy is a complex procedure with high morbidity and mortality. Anastomotic leakage is more severe and frequent in patients with preoperative comorbidities and may present with septic conditions. Considering the possibility of an easier management of such cases, we evaluated the safety and feasibility of subcutaneous esophageal reconstruction in patients with high operative risks. Methods: We performed a non-randomized retrospective observational study on the 75 (subcutaneous: 21, intrathoracic: 54) esophageal cancer patients who underwent esophageal reconstruction either through subcutaneous or intrathoracic route between January 2003 and February 2015. Preoperative data including the estimated reasons for the selection of the subcutaneous route were obtained from medical charts. Clinical outcomes were evaluated and compared between the two groups. Results: The mean postoperative hospital stay was longer in the subcutaneous group than the overall group. Anastomotic leakage occurred more frequently in the subcutaneous group [10 (47.6{\%}) vs. 7 (13{\%}), P=0.004]. Three major leakages resulted in chronic cutaneous fistula, but were successfully treated by lower neck reconstruction using radial forearm fasciocutaneous free flap (RFFF). There was no in-hospital mortality in the subcutaneous group. Conclusions: Subcutaneous esophageal reconstruction in high-risk patients showed a higher rate of anastomotic leakage. However, easier correction without fatal septic conditions could be obtained by primary repair or flap reconstruction resulting in lower perioperative mortality. Therefore, esophageal reconstruction through the subcutaneous route is not recommended as a routine primary option. However, in highly selected patients with unfavorable preoperative comorbidities or intraoperative findings, especially those with poor blood supply to the graft, graft hematoma or edema, or gross tumor invasion to surrounding tissues, esophageal reconstruction through the subcutaneous route may carefully be considered as an alternative to the conventional surgical techniques.",
keywords = "Anastomotic leakage, Comorbidities, Esophageal reconstruction, Subcutaneous route",
author = "Chung, {Jae Ho} and Lee, {Sung Ho} and Eunjue Yi and Jae-Seung Jung and Han, {Jung Wook} and Kim, {Tae Sik} and Son, {Ho Sung} and Kim, {Kwang Taik}",
year = "2017",
month = "3",
day = "1",
doi = "10.21037/jtd.2017.03.02",
language = "English",
volume = "9",
pages = "675--684",
journal = "Journal of Thoracic Disease",
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TY - JOUR

T1 - A non-randomized retrospective observational study on the subcutaneous esophageal reconstruction after esophagectomy

T2 - Is it feasible in high-risk patients?

AU - Chung, Jae Ho

AU - Lee, Sung Ho

AU - Yi, Eunjue

AU - Jung, Jae-Seung

AU - Han, Jung Wook

AU - Kim, Tae Sik

AU - Son, Ho Sung

AU - Kim, Kwang Taik

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: Esophageal reconstruction after esophagectomy is a complex procedure with high morbidity and mortality. Anastomotic leakage is more severe and frequent in patients with preoperative comorbidities and may present with septic conditions. Considering the possibility of an easier management of such cases, we evaluated the safety and feasibility of subcutaneous esophageal reconstruction in patients with high operative risks. Methods: We performed a non-randomized retrospective observational study on the 75 (subcutaneous: 21, intrathoracic: 54) esophageal cancer patients who underwent esophageal reconstruction either through subcutaneous or intrathoracic route between January 2003 and February 2015. Preoperative data including the estimated reasons for the selection of the subcutaneous route were obtained from medical charts. Clinical outcomes were evaluated and compared between the two groups. Results: The mean postoperative hospital stay was longer in the subcutaneous group than the overall group. Anastomotic leakage occurred more frequently in the subcutaneous group [10 (47.6%) vs. 7 (13%), P=0.004]. Three major leakages resulted in chronic cutaneous fistula, but were successfully treated by lower neck reconstruction using radial forearm fasciocutaneous free flap (RFFF). There was no in-hospital mortality in the subcutaneous group. Conclusions: Subcutaneous esophageal reconstruction in high-risk patients showed a higher rate of anastomotic leakage. However, easier correction without fatal septic conditions could be obtained by primary repair or flap reconstruction resulting in lower perioperative mortality. Therefore, esophageal reconstruction through the subcutaneous route is not recommended as a routine primary option. However, in highly selected patients with unfavorable preoperative comorbidities or intraoperative findings, especially those with poor blood supply to the graft, graft hematoma or edema, or gross tumor invasion to surrounding tissues, esophageal reconstruction through the subcutaneous route may carefully be considered as an alternative to the conventional surgical techniques.

AB - Background: Esophageal reconstruction after esophagectomy is a complex procedure with high morbidity and mortality. Anastomotic leakage is more severe and frequent in patients with preoperative comorbidities and may present with septic conditions. Considering the possibility of an easier management of such cases, we evaluated the safety and feasibility of subcutaneous esophageal reconstruction in patients with high operative risks. Methods: We performed a non-randomized retrospective observational study on the 75 (subcutaneous: 21, intrathoracic: 54) esophageal cancer patients who underwent esophageal reconstruction either through subcutaneous or intrathoracic route between January 2003 and February 2015. Preoperative data including the estimated reasons for the selection of the subcutaneous route were obtained from medical charts. Clinical outcomes were evaluated and compared between the two groups. Results: The mean postoperative hospital stay was longer in the subcutaneous group than the overall group. Anastomotic leakage occurred more frequently in the subcutaneous group [10 (47.6%) vs. 7 (13%), P=0.004]. Three major leakages resulted in chronic cutaneous fistula, but were successfully treated by lower neck reconstruction using radial forearm fasciocutaneous free flap (RFFF). There was no in-hospital mortality in the subcutaneous group. Conclusions: Subcutaneous esophageal reconstruction in high-risk patients showed a higher rate of anastomotic leakage. However, easier correction without fatal septic conditions could be obtained by primary repair or flap reconstruction resulting in lower perioperative mortality. Therefore, esophageal reconstruction through the subcutaneous route is not recommended as a routine primary option. However, in highly selected patients with unfavorable preoperative comorbidities or intraoperative findings, especially those with poor blood supply to the graft, graft hematoma or edema, or gross tumor invasion to surrounding tissues, esophageal reconstruction through the subcutaneous route may carefully be considered as an alternative to the conventional surgical techniques.

KW - Anastomotic leakage

KW - Comorbidities

KW - Esophageal reconstruction

KW - Subcutaneous route

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DO - 10.21037/jtd.2017.03.02

M3 - Article

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JO - Journal of Thoracic Disease

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SN - 2072-1439

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