Skip to main content

Advertisement

SpringerLink
Log in

End-to-End Cervical Esophagogastric Anastomoses Are Associated with a Higher Number of Strictures Compared with End-to-Side Anastomoses

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

Abstract

Background

Leakage and benign strictures occur frequently after esophagectomy. The objective of this study was to analyze the outcome of hand-sewn end-to-end versus end-to-side cervical esophagogastric anastomoses.

Methods

A series of 390 consecutive patients who underwent esophagectomy with gastric conduit reconstruction was analyzed.

Results

The end-to-end technique was performed in 112 (29 %) patients and the end-to-side in 278 (71 %) patients. Anastomotic leakage occurred in 20 (18 %) patients with an end-to-end anastomosis versus 58 (21 %) patients with an end-to-side anastomosis (p = 0.50). A higher incidence in anastomotic strictures was seen in end-to-end anastomoses (48 (43 %)) compared with end-to-side anastomoses (89 (32 %); p = 0.04). Moreover, a median of 11 (7–17) dilations was necessary in patients with a benign anastomotic stricture in the end-to-end group compared with four (2–8) dilations in patients with a benign anastomotic stricture in the end-to-end group (p < 0.036). After multivariate analysis, the difference in anastomotic leakage rates remained nonsignificant (p = 0.74), whereas anastomotic stricture rate and number of dilations were higher in the end-to-end group (p = 0.03 and p = 0.01, respectively).

Conclusion

The technique of anastomosis is not significantly related to anastomotic leakage rate. However, patients with end-to-end anastomoses develop postoperative strictures more frequently, requiring a higher number of dilations compared to end-to-side anastomoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007; 246 (6):992–1000; discussion 1000–1

    Article  PubMed  Google Scholar 

  2. Nederlof N, Tilanus HW, Tran TC, Hop WC, Wijnhoven BP, de Jonge J. End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann Surg 2011; 254(2):226–233.

    Article  PubMed  Google Scholar 

  3. Sarela AI, Tolan DJ, Harris K, Dexter SP, Sue-Ling HM. Anastomotic leakage after esophagectomy for cancer: a mortality-free experience. J Am Coll Surg 2008; 206(3):516–523.

    Article  PubMed  Google Scholar 

  4. Honkoop P, Siersema PD, Tilanus HW, Stassen LP, Hop WC, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg. 1996;111(6):1141–6; discussion 1147–8

    Article  PubMed  CAS  Google Scholar 

  5. van Heijl M, Gooszen JA, Fockens P, Busch OR, van Lanschot JJ, van Berge Henegouwen MI. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg 2010; 251(6):1064–1069.

    Article  PubMed  Google Scholar 

  6. Donington JS. Functional conduit disorders after esophagectomy. Thorac Surg Clin 2006; 16(1):53–62.

    Article  PubMed  Google Scholar 

  7. Pierie JP, De Graaf PW, Poen H, Van Der Tweel I, Obertop H. End-to-side and end-to-end anastomoses give similar results in cervical oesophagogastrostomy. Eur J Surg 1995; 161(12):893–896.

    PubMed  CAS  Google Scholar 

  8. Ndoye JM, Dia A, Ndiaye A, Fall B, Diop M, Ndiaye A, et al. Arteriography of three models of gastric oesophagoplasty: the whole stomach, a wide gastric tube and a narrow gastric tube. Surg Radiol Anat 2006; 28(5):429–437.

    Article  PubMed  Google Scholar 

  9. Haverkamp L, van der Sluis PC, Ruurda JP, R. van Hillegersberg R. Letter RE: End-to-end versus end-to-side esophagogastrostomy after esophageal cancer resection: a prospective randomized study. Ann of Surg. 2013 (in press)

  10. Sutton DN, Wayman J, Griffin SM. Learning curve for oesophageal cancer surgery. Br J Surg 1998; 85(10):1399–1402.

    Article  PubMed  CAS  Google Scholar 

  11. Song SY, Na KJ, Oh SG, Ahn BH. Learning curves of minimally invasive esophageal cancer surgery. Eur J Cardiothorac Surg 2009; 35(4):689–693.

    Article  PubMed  Google Scholar 

  12. Boone J, Livestro DP, Elias SG, Borel Rinkes IH, van Hillegersberg R. International survey on esophageal cancer: part I surgical techniques. Dis Esophagus 2009;22(3):195–202.

    Article  PubMed  Google Scholar 

  13. McLarty AJ, Deschamps C, Trastek VF, Allen MS, Pairolero PC, Harmsen WS. Esophageal resection for cancer of the esophagus: long-term function and quality of life. Ann Thorac Surg 1997; 63(6):1568–1572.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    Leonie Haverkamp, Pieter C. van der Sluis, Jelle P. Ruurda & Richard van Hillegersberg

  2. Department of Surgery, Jeroen Bosch Ziekenhuis, PO Box 90153, 5200 ME, ‘s‐Hertogenbosch, The Netherlands

    Roy J. J. Verhage

  3. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands

    Peter D. Siersema

Authors
  1. Leonie Haverkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pieter C. van der Sluis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roy J. J. Verhage
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter D. Siersema
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jelle P. Ruurda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard van Hillegersberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jelle P. Ruurda.

Additional information

This study was presented at the 13th World Congress of the International Society of Disease of the Esophagus (ISDE) on 15–17 October 2012 in Venice, Italy and at the 20th United European Gastroenterology Week (UEGW) on 20–24 October 2012 in Amsterdam, the Netherlands.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haverkamp, L., van der Sluis, P.C., Verhage, R.J.J. et al. End-to-End Cervical Esophagogastric Anastomoses Are Associated with a Higher Number of Strictures Compared with End-to-Side Anastomoses. J Gastrointest Surg 17, 872–876 (2013). https://doi.org/10.1007/s11605-013-2159-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2159-8

Keywords

Search

Navigation