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Incidence and Impact of Preoperative Hiatal Hernia in Patients with Esophageal Carcinoma Undergoing Curative Surgical Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Hiatal hernia (HH) and gastroesophageal reflux disease (GERD) are risk factors for esophageal adenocarcinoma. High positive margin rates and poor survival were described among HH patients undergoing esophagectomy. We sought to describe incidence and impact of HH on outcomes following esophagectomy.

Methods

Patients who underwent esophagectomy 2012–2019 for esophago-junctional carcinoma were included. CT studies were blindly reviewed by two radiologists. A third radiologist reviewed cases of disagreement. Hernias ≥ 3 cm were included in the HH group.

Results

Overall, 66 patients (33%) had HH ≥ 3 cm. The no hernia group included 12 patients (6%) with < 3 cm HH and 106 (53%) without HH. Preoperative variables were comparable among groups. Location of anastomosis was similar among cohorts and predominantly cervical (n = 97, 82.2% vs 61, 92.4%, p = 0.113). Postoperatively, HH patients had higher incidence of atrial dysrhythmia (n = 11, 16.7% vs n = 6, 5.1% p = 0.015). Rates of R0 resections were similar (n = 62, 93.9%, vs n = 113, 95.8%, p = 0.724). HH patients had higher rates of signet ring cell histology (n = 14, 21.2% vs n = 9, 7.6% p = 0.025); this was confirmed on subgroup analysis including only adenocarcinoma patients (n = 14, 28.6% vs n = 8, 12.3%, p = 0.042). On Cox regression analysis, HH was not associated with disease-free or overall survival (HR 1.308, p = 0.274 and HR .905, p = 0.722).

Conclusions

Patients with preoperative HH had higher rates of postoperative atrial dysrhythmias and signet ring cell features on pathology. In a population with predominant cervical anastomosis, positive margin rates were low and survival comparable among cohorts.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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  1. Adi Zaslavsky and Daniel Solomon contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel

    Adi Zaslavsky MD, Daniel Solomon MD, Tal Israeli MD & Hanoch Kashtan MD

  2. Department of Radiology, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel

    Danielle Varon MD, Yelena Amlinsky MD & Shlomit Tamir MD

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Contributions

AZ and DS contributed to conception and study design of the research; data acquisition, analysis and interpretation; manuscript drafting. Both approved the final version.

DV, TI, and YA contributed to data acquisition, manuscript revision, and approved the final version.

ST and HK contributed to study conception and design, revised the manuscript, and approved the final version.

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Correspondence to Daniel Solomon MD or Hanoch Kashtan MD.

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This research work was presented at the 2022 World Congress for Esophageal Diseases on September 26th, 2022.

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Zaslavsky, A., Solomon, D., Varon, D. et al. Incidence and Impact of Preoperative Hiatal Hernia in Patients with Esophageal Carcinoma Undergoing Curative Surgical Resection. J Gastrointest Surg 27, 2907–2919 (2023). https://doi.org/10.1007/s11605-023-05872-w

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