Routine Contrast Radiology After Oesophagectomy and Total Gastrectomy
Paul Finn*, S. Dresner, H. Wescott, Peter a. Davis
Upper Gastrointestinal Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
AIM
Routine contrast radiography following subtotal oesophagectomy (STO) and total gastrectomy (TG) is still widely practiced in the UK. This study aimed to evaluate a protocol of the selective use of contrast radiography after surgery.
METHODS
179 patients (median age 65 years, M:F 3.1:1) underwent STO (n=120) and TG (n=59) for malignancy from 01-April-2006 to 30-September-2010. 127 patients (routine group) underwent contrast swallows on days 3-7 post-operatively, whereas 52 patients (selective group) only had contrast radiography if clinically indicated.
RESULTS
125 (98.4%) patients in the routine group received contrast swallows whereas only six (11.5%) patients in the selective group underwent contrast radiography. Ten patients (5.6%) developed anastomotic leaks, four of which were not identified at initial routine radiography (sensitivity 55.6%, specificity 99.2%). Evidence of a leak occurred in a further four patients after an apparently normal contrast examination. Anastomotic leak rates did not differ significantly between STO (6.7%) and TG (3.4%), or between the routine (7.1%) and selective (1.9%) group. Length of stay (median 14 days) and in-hospital mortality also did not differ significantly between the routine (3.1%) and selective group (0%). Post-operative radiological costs were significantly higher in the routine group.
CONCLUSION
Routine contrast radiography cannot be recommended after STO or TG. The leak rate is low and a highly selective approach to the use of contrast radiography is both safe and cheaper.
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