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Postoperative Outcomes and Quality of Life After Left Thoracoabdominal Esophagogastrectomy: Contrasting Esophagogastrostomy with Esophagojejunostomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Following left thoracoabdominal (LTA) esophagogastrectomy, gastrointestinal continuity can be re-established via esophagogastrostomy or esophagojejunostomy. We explored how the method of reconstruction impacted postoperative outcomes and quality of life (QoL).

Methods

From January 2007 to January 2022, patients undergoing LTA were identified from a single center’s prospectively maintained database. Following esophagogastrectomy or extended total gastrectomy, an esophagogastrostomy (GAS) or Roux-en-Y esophagojejunostomy (R-Y) was fashioned. Postoperative outcomes were compared according to the method of reconstruction. The Functional Assessment of Cancer Therapy-Esophagus (FACT-E) questionnaire compared QoL.

Results

Of the 147 LTA patients identified, 135 (92%) were included—97 GAS (72%) and 38 R-Y patients (28%). R-Y patients had more ypT3/4 lesions (97% vs. 61%, p ≤ 0.001) and a similar incidence of ypN+/M+ disease. Anastomotic leaks were more common among GAS patients (17% vs. 3%, p = 0.023), however grade 3/4 complications (26.6% vs. 19.4%, p = 0.498), reoperation, intensive care admission, hospital representation and readmission were similar. FACT-E data were available for 68/97 (70%) GAS patients and 22/38 (58%) R-Y patients, with scores for 80/21/24/18/23/24 patients at baseline/preoperatively/1 month/3–6 months/1–3 years/3+ years postoperatively, respectively. Comparing between the groups, the scores were similar at each timepoint. FACT-E improved between baseline and preoperatively (79, 34–124 vs. 102, 81–123, p = 0.027). Only at 3+ years were postoperative scores equivalent to preoperative values. GAS patients had more reflux and esophagitis >6 months postoperatively (54% vs. 13%, p = 0.048; 62% vs. 0%, p ≤ 0.001).

Conclusion

While the type of reconstruction did not affect QoL, it did affect the postoperative course.

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Author notes

  1. James Tankel and Devangi Patel have been contributed equally to this work.

Authors and Affiliations

  1. Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada

    James Tankel MBBS, Devangi Patel MD, Yenonatan Nevo MD, Sara Najmeh MD, Jonathan Spicer MD, PhD, David Mulder MD, Carmen Mueller MD, Lorenzo Ferri MD, PhD & Jonathan Cools-Lartigue MD, PhD

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James Tankel received a travel grant of $4000 from Medtronic and receives regular consulting fees from Google. Devangi Patel, Yenonatan Nevo, Sara Najmeh, Jonathan Spicer, David Mulder, Carmen Mueller, Lorenzo Ferri, and Jonathan Cools-Lartigue have no disclosures to declare.

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Tankel, J., Patel, D., Nevo, Y. et al. Postoperative Outcomes and Quality of Life After Left Thoracoabdominal Esophagogastrectomy: Contrasting Esophagogastrostomy with Esophagojejunostomy. Ann Surg Oncol 30, 8182–8191 (2023). https://doi.org/10.1245/s10434-023-13733-8

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