SSAT - Incidence and Risk Factors of Symptomatic Hiatal Hernia Following Resection for Gastric and Esophageal Cancer

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Incidence and Risk Factors of Symptomatic Hiatal Hernia Following Resection for Gastric and Esophageal Cancer
Andreas Andreou^*, Benjamin Struecker, Sascha Chopra, Panagiotis Fikatas, Igor M. Sauer, Johann Pratschke, Matthias Biebl
Department of General, Visceral and Transplantation Surgery, Campus Virchow-Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Charité Mitte, Charité – Universitaetsmedizin Berlin, Berlin, Germany

Background: Symptomatic hiatal hernia (HH) following resection for gastric or esophageal cancer is a potentially life-threatening event that may lead to emergent surgery. However, the incidence and risk factors of this complication remain unclear.
Methods: Data of patients who underwent resection for gastric or esophageal cancer between 2005 and 2012 were assessed and the incidence of symptomatic HH was evaluated. In addition, we investigated factors associated with an increased risk for the development of HH.
Results: During the study period, 471 patients underwent resection for gastric or esophageal cancer. The primary tumor was located in the stomach, cardia and esophagus in 36%, 24%, and 40% of the patients, respectively. After a median follow-up time of 35 months, the incidence of symptomatic HH requiring surgery was 2.8% (n = 13 patients). The median interval between gastric or esophageal resection and the diagnosis of HH was 15 (0.1-57) months. All patients underwent surgical hernia repair, 8 patients (61.5%) required an emergent procedure and 3 patients (23%) underwent bowel resection. Postoperative morbidity and mortality after HH repair was 38.5% and 7.7%, respectively. Factors associated with an increased risk for symptomatic HH included Body-Mass-Index (BMI) (median BMI with HH 27 [23-35] vs. BMI without HH 25 [15-51], P = .043), diabetes (HH rate: with diabetes, 6.3% vs. without diabetes, 2%, P = .034), tumor location (HH rate: gastric cancer, 1.2% vs. esophageal cancer, 1.1% vs. cardia cancer, 7.9%, P = .001), and the resection type (HH rate: total/subtotal gastrectomy, 0.7% vs. transthoracic esophagectomy, 2.7% vs. extended gastrectomy, 6.1%, P = .038).
Conclusion: HH is a major adverse event after resection for gastric or esophageal cancer especially among patients undergoing extended gastrectomy for cardia cancer requiring a high rate of repeat surgery. Therefore, intensive follow-up examinations for high-risk patients and early diagnosis of asymptomatic patients are essential for the selection of patients for elective surgical treatment in order to avoid unpredictable emergent events with high morbidity and mortality.

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