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Impact of zero anastomotic leakage after esophagectomy followed by whole stomach reconstruction for esophageal cancer: prospective cohort study

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Abstract

Purpose

The stomach is the most common organ which is used for reconstruction after esophagectomy for esophageal cancer. It is controversial which is better narrow gastric tube reconstruction or whole stomach reconstruction to prevent anastomotic leakage.

Methods

From August 2022 to March 2023, we started a prospective cohort study of whole stomach reconstruction after esophagectomy. Until then (from January 2018 to July 2022), narrow gastric tube reconstruction was performed as a standard reconstruction.

Results

Narrow gastric tube reconstruction and whole stomach reconstruction were performed in 183 patients and 20 patients, respectively. The patient’s characteristics were not significantly different between the narrow gastric tube group and the whole stomach group. In particular, for all patients in the whole stomach reconstruction group, retrosternal route and esophagogastrostomy by hand sewn were applied. There were no occurrences of AL through the continuous 20 cases in the whole stomach group, otherwise 42 (22.9%) patients in the narrow gastric group (P = 0.016). Postoperative hospital stays were significantly shorter in the whole stomach group than in the narrow gastric group (21 days vs. 28 days, P < .001). Blood perfusions were evaluated by indocyanine green for all cases, which had very good blood perfusion in all cases. Additionally, quantitative blood perfusion was examined by SPY-QP (Stryker, USA) for one case. Even the edge of the fornix showed more than 90% blood perfusion levels when the antrum was fixed as the reference point.

Conclusion

Whole stomach reconstruction with excellent blood perfusion is considered to be safe and has the possibility to prevent from occurring AL after esophagectomy for esophageal cancer patients.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to hospital regulations but are available from the corresponding author on reasonable request.

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Acknowledgements

We acknowledge proofreading and editing by Benjamin Phillis from the Clinical Study Support Center at Wakayama Medical University.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Junya Kitadani, Toshiyasu Ojima, Keiji Hayata, Taro Goda, Akihiro Takeuchi, Shinta Tominaga, Naoki Fukuda, Tomoki Nakai, Shotaro Nagano & Manabu Kawai

Authors
  1. Junya Kitadani
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  2. Toshiyasu Ojima
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  3. Keiji Hayata
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  4. Taro Goda
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  5. Akihiro Takeuchi
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  6. Shinta Tominaga
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  7. Naoki Fukuda
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  8. Tomoki Nakai
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  9. Shotaro Nagano
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  10. Manabu Kawai
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Contributions

JK designed the study and wrote the initial draft of the manuscript. JK and TO contributed to data interpretation and critical revision of the manuscript. All other authors (KH, TG, AT, ST, NF, TN, SN, and MK) contributed to data collection and interpretation and critical review of the manuscript. All authors have read and approved the final version of the manuscript and have agreed to be accountable for all aspects of the study, ensuring that any queries related to the accuracy or integrity of any part of the work are answerable.

Corresponding author

Correspondence to Toshiyasu Ojima.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Wakayama Medical University Institutional Review Board. All procedures were undertaken in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and in accordance with the Helsinki Declaration of 1964 and later versions. All patients gave written informed consent in accordance with its guidelines.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Kitadani, J., Ojima, T., Hayata, K. et al. Impact of zero anastomotic leakage after esophagectomy followed by whole stomach reconstruction for esophageal cancer: prospective cohort study. Langenbecks Arch Surg 408, 451 (2023). https://doi.org/10.1007/s00423-023-03191-x

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  • DOI: https://doi.org/10.1007/s00423-023-03191-x

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