title: Covered stents in cervical anastomoses following esophagectomy.
abstract: Anastomotic complications after esophagectomy are relatively frequent. The off-label use of self-expanding covered metal stents has been shown to be an effective initial treatment for leaks, but there is a paucity of literature regarding their use in cervical esophagogastric anastomoses. We reviewed our outcomes with anastomotic stenting after esophagectomy with cervical esophagogastric reconstruction.
  
  
  
  All stents placed across cervical anastomoses following esophagectomy from 2004 to 2014 were retrospectively reviewed. Indications for surgery and stent placement were collected. For patients with serial stents, each stent event was evaluated separately and as part of its series. Success was defined as resolution of indicated anastomotic problem for at least 90 days. Complications were defined as development of stent-related problems.
  
  
  
  Twenty-three patients had a total of 63 stents placed (16 % prophylactic, 38 % leak, 46 % stricture). Sixty percent of patients had successful resolution of their initial anastomotic problem; 67 % required more than one stent. Strictures and leaks healed in 27 and 70 % of patients, respectively, at a median of 55.5 days. Stent-related complications occurred in 78 % of patients. Complications (per stent event) included 62 % migration, 11 % clinically significant tissue overgrowth, 8 % minor erosion (ulcers), and 8 % major erosion. Stents placed for stricture were more likely to result in complications, especially migration (76.7 vs. 48.5 %, p = 0.02). Preoperative chemoradiation was a significant risk factor for erosion (22.5 vs. 4.3 %, p = 0.05), but not for overall complications. Patients with major erosions had longer stent duration compared to those without (92 vs. 36 days, p = 0.14).
  
  
  
  Although stents are effective at controlling post-esophagectomy anastomotic leaks, they are not effective for treating strictures. Stents have high complication rates, but most are minor. Chemoradiation is a risk factor for stent erosion. Caution should be used when stent duration exceeds 2-3 months due to the risk of erosion.
authors.affiliation: Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Speer
authors.affiliation: Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA. cdunst@orclinic.com.|Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA. cdunst@orclinic.com.|Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA. cdunst@orclinic.com.
authors.forename: Christy M
authors.initials: CM
authors.lastname: Dunst
authors.affiliation: Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Shada
authors.affiliation: Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.affiliation: Department of Surgery, Providence Portland Medical Center, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Foundation for Surgical Innovation and Education, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.|Institut Hospitalo Universitaire Strasbourg, 1, Place de l'Hôpital, 97000, Strasbourg, France.
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanström
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D059248:Chemoradiotherapy / Q000009:adverse effects; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects
keywords: Anastomotic stricture; Complications; Esophageal leak; Esophagectomy; Stent