Functional disorders and quality of life after esophagectomy and gastric tube reconstruction for cancer.
Functional disorders such as delayed gastric emptying, dumping syndrome or duodeno-gastro-esophageal reflux occur in half of the patients who undergo esophagectomy and gastric tube reconstruction for cancer. The potential role for pyloroplasty in the prevention of functional disorders is still debated. Antireflux fundoplication during esophagectomy can apparently reduce the reflux but at the cost of increasing the complexity of the operation; it is not widely used. The treatment of functional disorders arising after esophagectomy and gastroplasty for cancer is based mainly on dietary measures. Proton pump inhibitors have well documented efficiency and should be given routinely to prevent reflux complications. Erythromycin may prevent delayed gastric emptying, but it should be used with caution in patients with cardiovascular disorders. In the event of anastomotic stricture, endoscopic dilatation is usually efficient. Problems related to gastrointestinal functional disorders after esophageal resection and gastric tube reconstruction do not significantly impair long-term quality of life, which is mainly influenced by tumor recurrence.
Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
T
T
Poghosyan
S
S
Gaujoux
M
M
Chirica
N
N
Munoz-Bongrand
E
E
Sarfati
P
P
Cattan
D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004377:Dumping Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects*; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*