title: Outcomes of minimally invasive esophagectomy without pyloroplasty: analysis of 109 cases.
abstract: Pyloroplasty is performed during esophagectomy to avoid delayed gastric emptying. However, studies have shown that gastric function is minimally impaired even without a pyloroplasty when a gastric tube rather than the whole stomach is used for reconstruction. The aim of this study was to evaluate outcomes of minimally invasive esophagectomy without performance of a pyloroplasty. We performed a retrospective review of 145 patients who underwent a minimally invasive esophagectomy. The 30-day mortality was 2.1 per cent with an in-hospital mortality of 3.4 per cent. Of the 140 patients with more than 90 days follow-up, 31 patients had a pyloroplasty and 109 patients did not. One (3.2%) of 31 patients with pyloroplasty versus six (5.5%) of 109 patients without pyloroplasty developed delayed gastric emptying. There was no significant difference in the leak rate between the two groups (9.7% vs. 9.6%, respectively). Total operative time was significantly shorter in the group without pyloroplasty (360 vs. 222 minutes with a pyloroplasty, P < 0.01). Patients with delayed gastric emptying responded well to endoscopic pyloric dilation or Botox injection. The routine performance of a pyloroplasty during minimally invasive esophagectomy can be safely omitted with a reduction in operative time and minimal adverse effects on postoperative gastric function.
authors.affiliation: Department of Surgery, University of California Irvine Medical Center, Orange, California 92868, USA. ninhn@uci.edu
authors.forename: Ninh T
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Chirag
authors.initials: C
authors.lastname: Dholakia
authors.forename: Xuan-Mai T
authors.initials: XM
authors.lastname: Nguyen
authors.forename: Kevin
authors.initials: K
authors.lastname: Reavis
mesh_terms: D000368:Aged; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D005746:Gastric Emptying; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome