title: Surgical prevention of reflux after esophagectomy for cancer.
abstract: BACKGROUND
  Reflux frequently occurs after a gastric conduit has replaced the resected esophagus. In this Swedish population-based cohort study, the potential antireflux effects of using cervical anastomosis, intrathoracic antireflux anastomosis, or pyloric drainage, and a risk of dysphagia due to cervical anastomosis and intrathoracic antireflux anastomosis were studied.
  
  
  METHODS
  Patients undergoing esophagectomy with gastric conduit reconstruction in 2001-2005 were included. Reflux symptoms and dysphagia were assessed 6 months and 3 years postoperatively using a validated questionnaire (EORTC QLQ-OES18). The study exposures were cervical anastomosis, antireflux anastomosis, and pyloric drainage procedure. Multivariable logistic regression and propensity-adjusted analyses based on multinomial logistic regression estimated odds ratios (OR) with 95 % confidence intervals (CI), adjusted for potential confounding.
  
  
  RESULTS
  A total of 304 patients were included in the study. Adjusted ORs for reflux symptoms were 0.9 (95 % CI 0.3-2.2) for patients with a cervical anastomosis compared to patients with an intrathoracic anastomosis, 0.9 (95 % CI 0.4-2.0) for patients with an antireflux anastomosis versus patients with a conventional anastomosis, and 1.5 (95 % CI 0.9-2.6) for patients after pyloric drainage versus patients without such a pyloric drainage procedure. Dysphagia was not statistically significantly increased after cervical anastomosis or antireflux anastomosis. ORs were virtually similar 3 years after surgery. No interactions were identified. The propensity analyses rendered similar results as the logistic regression models, except for a possibly increased dysphagia with a cervical anastomosis.
  
  
  CONCLUSIONS
  Cervical anastomosis, antireflux anastomosis, and pyloric drainage do not seem to prevent reflux symptoms 6 months or 3 years after esophagectomy for cancer with a gastric conduit.
authors.affiliation: Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. maartje.van.der.schaaf@ki.se
authors.forename: Maartje
authors.initials: M
authors.lastname: van der Schaaf
authors.forename: A
authors.initials: A
authors.lastname: Johar
authors.forename: P
authors.initials: P
authors.lastname: Lagergren
authors.forename: I
authors.initials: I
authors.lastname: Rouvelas
authors.forename: J
authors.initials: J
authors.lastname: Gossage
authors.forename: R
authors.initials: R
authors.lastname: Mason
authors.forename: J
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D004322:Drainage; D004938:Esophageal Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D015996:Survival Rate