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Predictive value of blood flow in the gastric tube in anastomotic insufficiency after thoracic esophagectomy

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Abstract

Anastomotic insufficiency is considered to be one of the most serious complications associated with esophageal reconstruction. The purposes of this study were to identify (1) the relationship between anastomotic insufficiency and tissue blood flow (TBF) in the gastric tube in the perioperative period, and (2) the effects of intravenous prostaglandin E1 (PGE1) on TBF in the gastric tube. The study group consisted of 44 patients who were to undergo esophagectomy for esophageal cancer. Intraoperative and postoperative TBF on the serosal side of the gastric tube were measured by laser-Doppler tissue blood flowmetry. The TBF of the Leakage(+) group (n=5) was poorer than that of the Leakage(−) group (n=39) during the intraoperative and postoperative periods. There was a significant difference in TBF between the two groups at postoperative day (POD) 3. There was a tendency in the PGE1(+) group (n=18) to exhibit richer blood flow through the anastomosis than the PGE1(−) group (n=26), intraoperatively, but the difference was not significant. Two of five Leakage(+) cases were also in the PGE11(+) group. There was no relationship between intraoperative medication with PGE1 and incidence of leakage. The TBF of three-field lymph node dissection and reconstruction of the retrosternal route group (n=21) was poorer than that of the two-field lymph-node dissection and reconstruction of the posterior mediastinal route group (n=23). The TBF in the gastric tube after esophagectomy may be a predictor of anastomotic insufficiency. However, PGE1 treatment in the intraoperative period alone is not effective in preventing anastomotic insufficiency.

Résumé

La fistule anastomotique après anastomose oesophagienne est une des complications les plus sévères. Les buts de cette étude ont été d’identifier: (1) dans la période postopératoire, les rapports entre la fistule anastomotique et le débit sanguin des tissus (DST) du tube gastrique, (2) les effets de la prostaglandine E1 (PGE1) administrée en intraveineux sur le DST du tube gastrique. Le groupe d’étude a comporté 44 patients ayant eu une œsophagectomie pour cancer de l’œsophage. Le DST a été mesuré au niveau de la séreuse du tube gastrique par une débitométrie sanguine au laser-Doppler en peropératoire et en postopératoire. Le DST mesuré en peropératoire et en postopératoire a été plus faible dans le groupe avec fistule (+) (n=5) que dans le groupe sans fistule (−) (n=39). Au jour postopératoire 3, la différence observée du DST des deux groupes a été significative. On a noté une tendance dans le groupe PGE1(+) (n=18) à un débit plus élevé à travers l’anastomose que dans le groupe PGE1(−) (n=26), en peropératoire, mais cette difference n’était pas significative. Deux des cinq cas de fistule (+) étaient dans le groupe PGE1(+). Il n’y avait aucun rapport entre la prise de PGE1 peropératoire et l’incidence de fistule. Le DST après oesophagectomie par trois champs et reconstruction par voie rétrosternale (n=21) était moins bon que celui de l’oesophagectomie par deux champs et reconstruction par voie médiastinale postérieure (n=23). Le DST du tube gastrique après oesophagectomie pourrait être un facteur prédictif de fistule anastomotique. Cependant, le traitement par PGE, pendant la période peropératoire seul n’est pas efficace dans la prévention de fistule anastomotique.

Resumen

La complicación más grave de las reconstrucciones esofágicas es la insuficiencia o fuga anastomótica. Los objetivos de este trabajo fueron: (1) establecer las relaciones existentes, durante el periodo perioperatorio, entre la insuficiencia o fuga anastomótica y el flujo sanguíneo tisular (TBF) del tubo gástrico, (2) averiguar los efectos de la administración intravenosa de prostaglandina E1 (PGE1) en el TBF del tubo gástrico. Estudiamos 44 pacientes esofagectomizados por cáncer. Utilizando un flujómetro sanguíneo textura! tipo Laser-Doppler se midió, en el periodo tanto intra como postoperatorio, el TBF en la serosa del tubo gástrico. Durante estos periodos el TBF, en el grupo insuficiencia o fuga anastomótica (+) n=5 fue menor que en el grupo sin insuficiencia (−) n=39. Se constató al tercer día del postoperatorio (POD) una diferencia muy significativa del TBF entre ambos grupos. Se registró en el grupo PGE1 (+) (n=18) en relación con el grupo PGE1 (−) (n=26) una tendencia no significativa por lo que a un mayor flujo sanguíneo textural, a través de la anastomosis, se refiere. Dos de las 5 insuficiencias anastomóticas se registraron en el grupo PGE1 (+). No hubo relación alguna entre la administración intraoperatoria de PGE1 y la frecuencia de la dehiscencia. El TBF en tres áreas ganglionares tras disección y reconstrucción retroesternal (n=21) fue menor, que en dos áreas anglionares tras disección y reconstrucción mediastínica posterior (n=23). El TBF del tubo gástrico es un factor pronóstico válido de la dehiscencia o fuga anastomótica. El tratamiento intraoperatorio con PGE, no es eficaz en la prevención de la misma.

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References

  1. Orringer MB, Marshall B, Stirling MC. Transhiatal esophagectomy for benign and malignant disease. J. Thorac. Cardiovasc. Surg. 1993;105:265–276

    PubMed  CAS  Google Scholar 

  2. Akiyama H, Tsurumaru M, Udagawa H, et al. Radical lymph node dissection for cancer of the thoracic esophagus. Ann. Surg. 1994;220:364–372

    Article  PubMed  CAS  Google Scholar 

  3. Fujita H, Kakegawa T, Yamana H, et al. Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection. World J. Surg. 1994;18:266–272

    Article  PubMed  CAS  Google Scholar 

  4. Yoshida M, Iwatsuki M. Extended lymph node dissection for thoracic esophageal cancer. In Siewert AH, Holscher AH, editors, Disease of the Esophagus, Pathophysiology, Diagnosis, Conservative and Surgical Treatment, Berlin, Springer-Verlag, 1998:421–426

    Google Scholar 

  5. Hennessy TP. Lymph node dissection. World J. Surg. 1994;18:367–372

    Article  PubMed  CAS  Google Scholar 

  6. Fujita H, Kakegawa T, Yamana H, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Ann. Surg. 1995;222:654–662

    Article  PubMed  CAS  Google Scholar 

  7. Sugimachi K, Yaita A, Ueno H, et al. A safer and more reliable operative technique for esophageal reconstruction using a gastric tube. Am. J. Surg. 1980;140:471–474

    Article  PubMed  CAS  Google Scholar 

  8. Sugimachi K, Ueo H, Natsuda Y, et al. Cough dynamics in oesophageal cancer: prevention of postoperative pulmonary complications. Br. J. Surg. 1982;69:734–736

    Article  PubMed  CAS  Google Scholar 

  9. Sugimachi K, Matsuzaki K, Matsuura H. et al. Evaluation of surgical treatment of the oesophagus in the elderly: 20 years experience. Br. J. Surg. 1985;72:28–30

    Article  PubMed  CAS  Google Scholar 

  10. Bardini R. Asolati M, Ruol A, et al. Anastomosis. World J. Surg. 1994;18:373–378

    Article  PubMed  CAS  Google Scholar 

  11. Matory YL, Burt M. Esophagogastrectomy: reoperation for complications. J. Surg. Oncol. 1993;54:29–33

    Article  PubMed  CAS  Google Scholar 

  12. Law SY, Fok M, Wong J. Risk analysis in resection of squamous cell carcinoma of the esophagus. World J. Surg. 1994;18:339–346

    Article  PubMed  CAS  Google Scholar 

  13. Kuwano H, Sumiyoshi K, Sonoda K, et al. Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer. Eur. J. Surg. 1998;164:581–586

    Article  PubMed  CAS  Google Scholar 

  14. Dewar L, Gelfand G, Finley RJ, et al. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am. J. Surg. 1992;163:484–489

    Article  PubMed  CAS  Google Scholar 

  15. Urschel JD. Esophagogastrectomy anastomotic leaks complicating esophagectomy: a review. Am. J. Surg. 1995;169:634–640

    Article  PubMed  CAS  Google Scholar 

  16. Pierie JP, De Graaf PW, Poen H, et al. Impaired healing of cervical oesophagogastrostomies can be predicted by estimation of gastric serosal blood perfusion by laser-Doppler flowmetry. Eur. J. Surg. 1994;160:599–603

    PubMed  CAS  Google Scholar 

  17. Tarui T, Murata A, Watanabe Y, et al. Earlier prediction of anastomotic insufficiency after thoracic esophagectomy by intramucosal pH. Crit. Care. Med. 1999;27:1824–1831

    Article  PubMed  CAS  Google Scholar 

  18. Moneada S, Flower RJ, Vane JR. Prostaglandins, prostacyclin, thromboxane A2, and leukotrienes. In Gilman AG, Goodman LS, Rall TW, Murad F, editors, The Pharmacological Basis of Therapeutics. 7th edition, New York, Macmillan, 1985:660–673

    Google Scholar 

  19. Oka S. A canine model for measuring tissue blood flow of small intestine by laser flowmetry. Kitasato Med. 1988;18:631–640

    Google Scholar 

  20. Mackie DB, Chir M, Turner MD. The effect of truncal vagotomy on jejunal and ileal blood flow. J. Surg. Res. 1971;11:356–363

    Article  Google Scholar 

  21. Mishima Y, Shigematsu H, Horie Y, et al. Measurement of local blood flow of the intestine by hydrogen clearance method: experimental study. Jpn. J. Surg. 1979;9:63–70

    Article  PubMed  CAS  Google Scholar 

  22. Chou CC, Grassmick B, Motility and blood flow distribution within the wall of the gastrointestinal tract. Am. J. Physiol. 1978;235:H34–39

    PubMed  CAS  Google Scholar 

  23. Fan FC, Schuessler GB, Chen RYZ, et al. Determination of blood flow and shunting of 9 and 15-micrometer spheres in regional beds. Am. J. Physiol. 1979;237:H25–33

    PubMed  CAS  Google Scholar 

  24. Shepherd AP, Riedel GL. Continuous measurement of intestinal mucosal blood flow by laser-Doppler velocimetry. Am. J. Phvsiol. 1982;242:G668–672

    CAS  Google Scholar 

  25. Shepherd AP, Riedel GL. Differences in reactive hyperemia between the intestinal mucosa and musclaris. Am. J. Physiol. 1984;247:G617–622

    PubMed  CAS  Google Scholar 

  26. Kvietys PR, Sheperd AP, Granger DN. Laser-Doppler, H2 clearance, and microsphere estimates of mucosal blood flow. Am. J. Physiol. 1985;249:G221–227

    PubMed  CAS  Google Scholar 

  27. Matsuzaki Y, Edagawa M, Maeda M, et al. Beneficial effect of prostaglandin E1 on blood flow to the gastric tube after esophagectomy. Ann. Thorac. Surg. 1999;67:908–910

    Article  PubMed  CAS  Google Scholar 

  28. Kuwano H, Ikebe M, Baba K, et al. Operative procedures of reconstruction after resection of esophageal cancer and postoperative quality of life. World J. Surg. 1993;17:773–776

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery I, Gunma University Faculty of Medicine, 3-39-22, Showa-machi, Maebashi, 371-8511, Gunma, Japan

    Tatsuya Miyazaki M.D., Hiroyuki Kuwano M.D., Ph.D., Hiroyuki Kato M.D., Ph.D., Minako Yoshikawa M.D., Hitoshi Ojima M.D., Ph.D. & Katsuhiko Tsukada M.D., Ph.D.

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  1. Tatsuya Miyazaki M.D.
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  2. Hiroyuki Kuwano M.D., Ph.D.
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  3. Hiroyuki Kato M.D., Ph.D.
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  4. Minako Yoshikawa M.D.
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  5. Hitoshi Ojima M.D., Ph.D.
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  6. Katsuhiko Tsukada M.D., Ph.D.
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Correspondence to Tatsuya Miyazaki M.D..

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Published Online: September 26, 2002

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Miyazaki, T., Kuwano, H., Kato, H. et al. Predictive value of blood flow in the gastric tube in anastomotic insufficiency after thoracic esophagectomy. World J. Surg. 26, 1319–1323 (2002). https://doi.org/10.1007/s00268-002-6366-9

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  • DOI: https://doi.org/10.1007/s00268-002-6366-9

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