Does celiac trunk stenosis correlate with anastomotic leakage of esophagogastrostomy after esophagectomy?
The formation of a gastric tube for esophageal replacement requires partial devascularization of the stomach and induces microcirculatory changes in the anastomotic region of the gastric fundus. The additional influence of celiac trunk stenosis on anastomotic healing has not been investigated. In total, 23 patients with an esophageal carcinoma underwent transthoracic esophagectomy. Reconstruction was performed by a gastric tube (x22) with cervical or thoracic esophagogastrostomy or colon interposition (x1). All patients had a selective mesenterico-celiacography preoperatively via puncture of the right femoral artery. Preoperative cardiovascular and pulmonary risk factors were assessed. Angiographic findings were correlated to postoperative anastomotic leakage of esophagogastrostomy (x22). In seven out of 23 patients (30.4%), a stenosis of the celiac trunk could be demonstrated (x3 stenosis of 50%, x4 stenosis > 80%). Except for one patient with an additional stenosis of the superior mesenteric artery of > 80%, none of the patients with celiac trunk stenosis developed a postoperative anastomotic leakage of the esophagogastrostomy. Coronary artery disease was the only preoperative risk factor to predict a stenosis of the celiac trunk. Isolated stenosis of the celiac trunk does not seem to impair circulation of the gastric tube.
Schröder
W
W
Departments of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany. Wolfgang.Schroeder@uni-Koeln.de
Zähringer
M
M
Stippel
D
D
Gutschow
C
C
Beckurts
K T E
KT
Lackner
K
K
Hölscher
A H
AH
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002445:Celiac Artery / Q000473:pathology*; D003251:Constriction, Pathologic; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D013529:Surgical Wound Dehiscence