Dysphagia After Esophagectomy for Esophageal Cancer: a Common Problem After Collar but Not After Intrathoracic Anastomosis
Alexandra Koenig*, Dean Bogoevski, Maximilian Bockhorn, Matthias Reeh, Yogesh K. Vashist, Thomas Roesch, Emre F. Yekebas, Jakob Izbicki
University Medical Centre of Hamburg-Eppendorf, Hamburg, Germany, Hamburg, Germany
Objective: To assess the impact of site of anastomosis on dysphagia in esophageal carcinoma.Summary Background Data: As overall survival after esophageal cancer surgery remains poor, postoperative quality of life has gained importance as an additional outcome parameter. While the two most commonly used reconstructive methods, intrathoracic and collar anastomosis, have shown similar oncologic effectiveness, it remains undecided whether subsequent quality of life is different. The present analysis compares these reconstruction methods, focusing on dysphagia as the main postoperative symptom.Methods: Between 2003 and 2007, 71 patients (mean age 61.5 years; 72% male, 28% female) with complete resection of esophageal carcinomas (37 adenocarcinomas, 34 squamous cell cancers) and with long-term survival of at least 18 months were contacted and completed a modified quality of life (QoL) questionnaire (median 24.1 months after surgery). Our analysis compared the reconstruction groups using a gastric tube with either collar (group A; n=36) or high intrathoracic anastomosis (group B; n=35). In order to quantify the given answers from the patients and the extent of the dysphagia, we have devised a scoring system. For each question we have assigned a point allocation, depending on the impact of the symptoms or grade of dysphagia.Results: Postoperatively, the rate of surgical complications of our study population was 27.8 % (anastomotic leakage 22.2%) in group A vs. 11.4 % in group B (p=0.075). The long-term follow-up showed symptoms of dysphagia in 29 patients (group A, n=20; group B, n=9; p=0.007). Significantly more patients within group A had to undergo endoscopic bougienage (13 vs. 1, p<0.0001). The scoring system showed significantly severe symptoms in patients with collar anastomosis (median 17) compared to intrathoracic anastomosis (median 8).Conclusion: High intrathoracic anastomosis appears to carry a lower risk for dysphagic symptoms compared with collar anastomosis, and should therefore be the preferred method for reconstruction after surgical resection of esophageal carcinoma.
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