Omentoplasty in preventing anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.
OBJECTIVE
Anastomotic leakage is a major cause of mortality in oesophageal surgery. Whether omentoplasty after oesophagogastrostomy could reduce anastomotic leakage is still controversial. The aim of this study is to investigate the function of omentoplasty to reinforce cervical oesophagogastrostomy after radical oesophagectomy with three-field lymphadenectomy.


METHODS
A total of 184 patients who underwent radical oesophagectomy with three-field lymphadenectomy took part in this prospective study. Patients were randomized to receive either the omentoplasty or non-omentoplasty. In the omentoplasty group, the omentum was wrapped around the oesophagogastric anastomosis after oesophagogastrostomy. Age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease, peripheral vascular disease and performance of omentoplasty were recorded. The anastomotic leakage and stricture and recurrence site were followed up for three years after the operation.


RESULTS
The two groups were comparable in terms of age, gender, location of carcinoma, stage, body mass index, diabetes, coronary artery disease and peripheral vascular disease (P > 0.05). In contrast to the non-omentoplasty group with a postoperative anastomotic leakage rate of 9.8%, the omentoplasty subjects demonstrated a significantly lower rate of 3.3% (P < 0.05). No lethal leakage was found in the omentoplasty group, while two non-omentoplasty patients developed incurable empyema and mediastinitis due to leakage and ultimately died. The rate of incidence of anastomotic stricture in the omentoplasty and non-omentoplasty groups were 4.3% and 2.2% respectively. Of the five cases of death during the hospital stay, two were found in the omentoplasty group and three in non-omentoplasty. There was no significant difference of lethal leakage, stricture and death rate between the two groups (P > 0.05). The hospital stay was significantly longer for non-omentoplasty patients, compared with that for the omentoplasty subjects (P < 0.05). Tumour recurrence in lymphatic- or haematogenous metastasis was similar in both groups (P > 0.05).


CONCLUSIONS
Omentoplasty may prevent anastomotic leakage of oesophagogastrostomy following radical oesophagectomy with three-field lymphadenectomy.
Department of Thoracic Surgery, Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou, China. zhqf@msn.com
Qing-Feng
QF
Zheng
Jian-Jun
JJ
Wang
Min-Gang
MG
Ying
Shou-Yan
SY
Liu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D016629:Esophagectomy / Q000379:methods; D004946:Esophagostomy / Q000379:methods; D005260:Female; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D011446:Prospective Studies