Published online Nov 27, 2019. doi: 10.4240/wjgs.v11.i11.407
Peer-review started: May 20, 2019
First decision: August 2, 2019
Revised: October 16, 2019
Accepted: November 4, 2019
Article in press: November 4, 2019
Published online: November 27, 2019
Benign oesophageal strictures carry a significant level of morbidity, causing burdensome symptoms impacting on quality of life. Post-oesophagectomy anastomotic stricture rates as high as 41% have been reported in the literature. These can require endoscopic dilatation, often multiple times to relieve dysphagia. The aim of the present study was to determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures, and to identify any independent risk factors in their development.
To determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures, and to identify any independent risk factors in their development.
We performed a retrospective analysis of a prospectively collected database of Ivor-Lewis oesophagectomy performed from 2004-2018 to determine the stricture rate. The database comprised a single-surgeon series of open, two-stage oesophagectomies with a circular stapled intra-thoracic anastomosis. Tumour location, histology, neoadjuvant chemotherapy, stapler size, T-stage and R-status were analysed to see if they could predict stricture formation. Stricture was defined as dysphagia requiring endoscopic dilatation. Patients with anastomotic leaks were excluded on the basis they would develop an anastomotic stricture.
One hundred and seventy patients were collected in the database. Nineteen were excluded on the basis of anastomotic leak, perioperative death and early recurrence. One hundred and fifty-four patients (119 males, 35 females) with a mean age of 64 ± 10 years were eligible for analysis. A total of 15 patients developed strictures a median of 99 d (interquartile range: 84-133) after surgery, giving a Kaplan-Meier estimated stricture rate of 10% at one year. None of the factors considered were found to be significantly associated with strictures.
In this study the stricture rate was 10%, with the majority occurring in the first 100 d after surgery. No significant independent factors were found in the development of strictures.
Core tip: Heavy debate exists on anastomotic technique at oesophagectomy to reduce the incidence of post-operative stricture. This study would represent the largest published series of circular stapled intrathoracic anastomoses to look at stricture rates. It finds a 10% stricture rate in 154 patients, with a median time to stricture of 99 d. It highlights that this technique gives an acceptable stricture rate when compared with other techniques. Furthermore, it stresses the importance of close clinical follow-up in the first six months to avoid missing this highly morbid complication and encourages open access clinic appointments for patients with early symptoms of dysphagia.