title: Esophageal reinforcement with an extracellular scaffold during total gastrectomy for gastric cancer.
abstract: BACKGROUND
  Esophagojejunal (EJ) anastomotic leaks after total gastrectomy (TG) for malignancy lead to significant morbidity and mortality, thus affecting long-term survival. Preclinical and clinical trials have shown promise in utilizing degradable extracellular matrix (ECM) scaffolds in buttressing anastomoses. We describe our experience buttressing the EJ anastomosis after TG with a ECM scaffold.
  
  
  METHODS
  From February 2012 to January 2014, a total of 37 consecutive patients underwent TG buttressing of the EJ anastomosis with the degradable ECM scaffold composed of a porcine urinary bladder called MatriStem (ACell Inc.). The scaffold was circumferentially wrapped around the EJ anastomosis. The primary end point was the EJ leak rate, while the secondary end point was the EJ stricture rate.
  
  
  RESULTS
  The mean ± SD age and body mass index were 59 ± 16 years and 28.1 ± 4.9 kg/m(2), respectively. Most patients were male (51 %), white (78 %), and former smokers (51 %). Over half (59 %) underwent neoadjuvant chemotherapy. A minimally invasive TG was performed in 70 % of patients. Signet ring was the most common tumor type (48 %), and most patients had midstage disease (59 %). The mean number of lymph nodes procured was 36 ± 16. Eighteen patients (49 %) experienced a complication, mostly minor. One patient (2.7 %) developed an EJ leak, while three patients (8 %) developed an EJ stricture. Median follow-up was 7 months (range 2-12 months). There was no operative or in-hospital mortality.
  
  
  CONCLUSIONS
  The use of urinary bladder matrix scaffolds may be helpful in decreasing the incidence of EJ anastomotic leak and/or stricture. A prospective phase II trial at our institution is currently under way.
authors.affiliation: Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Cheguevara
authors.initials: C
authors.lastname: Afaneh
authors.forename: Jonathan
authors.initials: J
authors.lastname: Abelson
authors.forename: Mark
authors.initials: M
authors.lastname: Schattner
authors.forename: Yelena Y
authors.initials: YY
authors.lastname: Janjigian
authors.forename: David
authors.initials: D
authors.lastname: Ilson
authors.forename: Sam S
authors.initials: SS
authors.lastname: Yoon
authors.forename: Vivian E
authors.initials: VE
authors.lastname: Strong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000517:prevention & control*; D004947:Esophagus / Q000601:surgery*; D005109:Extracellular Matrix; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D017792:Surgical Stapling / Q000295:instrumentation* / Q000379:methods; D014945:Wound Healing; D055815:Young Adult