[Cervical anastomotic stenosis after gastric tube reconstruction in esophageal carcinoma. Evaluation of a patient sample 1989-1995].
Common late complications after esophagectomy and gastric tube reconstruction for esophageal carcinoma are symptomatic, benign fibrotic stenoses of the cervical anastomosis, which require dilatation. Since the prognosis of esophageal carcinoma still remains poor, bad functional results such as dysphagia affect quality of life. In a retrospective analysis, our patients were evaluated with regard to the underlying effects of cervical anastomotic stenosis after esophagectomy and gastric tube reconstruction. From 1 January 1989 to 31 July 1995, 173 patients with carcinoma of the esophagus were operated in our institution. Transhiatal esophageal dissection was performed in 133 patients; 40 patients underwent transthoracic en bloc resection. The 30-day mortality rate was 7.5% (13 patients). Postoperative fibrotic stenosis of the cervical anastomosis requiring dilatation occurred in 36.4% (63 patients) 6-12 weeks after operation. Fibrotic stenosis of the cervical anastomosis did not develop in 97 patients. There was a significant difference concerning the incidence of anastomotic leaks within both groups: whereas in 23.8% of the 63 patients who developed a fibrotic stricture of the cervical anastomosis an anastomotic leak preceded this event (P < 0.001), no anastomotic leak occurred in the group of 97 patients with normal healing of the cervical anastomosis. In addition, significantly (P < 0.01) more patients (37.5%, n = 23) with preexisting diabetes mellitus could be found among the 63 patients who developed a fibrotic stricture of the cervical anastomosis, in contrast to the 97 patients without anastomotic stenosis.
Bruns
C J
CJ
Klinik und Poliklinik für Chirurgie, Universität Köln.
Gawenda
M
M
Wolfgarten
B
B
Walter
M
M
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D048909:Diabetes Complications; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016629:Esophagectomy; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014945:Wound Healing / Q000502:physiology