|
Back to 2014 Annual Meeting Posters
Factors Contributing to Foregut Failure After Esophageal Cancer Resection
John S. Bolton*, William C. Conway
Surgery, Ochsner Clinic, New Orleans, LA
Introduction: Long-term survivors after esophageal cancer resection (ECR) have significantly lower quality of life (QOL) than survivors after resection of other cancer sites, and inferior QOL after ECR is strongly associated with impairment of swallowing function. However, the etiology and frequency of delayed foregut function has received little systematic study to date.
Methods: 205 consecutive patients submitted to ECR with gastric conduit reconstruction between 2004-2013 and who survived the early postoperative period form the basis of this report. Patients who were unable to re-establish ad lib nutritional intake per os by 3 months postoperatively were considered ‘Foregut Failures' (FF) and the factors associated with FF were analyzed in detail.
Results: The overall incidence of FF in this study population was 28/205 (14%), and the risk of FF was significantly associated (p<0.01) with specific postoperative complications, as detailed in Table 1:
Conclusion: Anastomotic leaks and strictures are relatively common complications but infrequently cause FF, especially when they occur in the absence of other complications. CN, RLN paresis with aspiration, and prolonged DGE are relatively infrequent complications, but have a high rate of FF. Both primary prevention and early, aggressive diagnosis and treatment of CN and RLN paresis can reduce the FF rate of CN and RLN paresis with aspiration. While there is no effective preventative or treatment strategy for prolonged DGE, the prognosis for recovery of FF with this complication is good.
| Complication | # (%) patients with complication | # (%) with FF | # (%) with eventual resolution of FF | | Conduit necrosis (CN) | 8 (4%) | 8/8 (100%) | 3/8 (38%) | | Anastomotic leak without CN | 34 (17%) | 7/34 (21%) | 4/7 (57%) | | Recurrent laryngeal nerve (RLN) paresis without aspiration | 15 (7%) | 1/15 (7%) | 1/1 (100%) | | RLN paresis with aspiration | 10 (5%) | 7/10 (70%) | 6/7 (86%) | | Aspiration without RLN paresis | 8 (4%) | 3/8 (38%) | 2/3 (67%) | | Prolonged delayed gastric emptying (DGE) | 13 (6%) | 10/13 (77%) | 7/10 (70%) | | Anastomotic stricture | 57 (28%) | 11/57 (19%) | 10/11 (91%) |
Back to 2014 Annual Meeting Posters
|
