INTRA-THORACIC FUNDOPLICATION GASTROPEXY IMPROVES REFLUX AND QUALITY OF LIFE IN PATIENTS UNDERGOING ESOPHAGECTOMY
Caitlin Takahashi-Pipkin*3, Ravi Shridhar4, Jamie Huston1, Kenneth L. Meredith2
1Sarasota Memorial Hospital, Sarasota, FL; 2Florida State University/ Sarasota Memorial Hospital, Sarasota, FL; 3East Carolina University/Vidant Medical Center, Greenville, NC; 4Florida Hospital, Tampa, FL
Introduction:
Patients undergoing esophagectomy are sentenced to a life in which they are at constant risk for reflux both when upright or recumbent. Recent data on pH testing after esophagectomy revealed esophageal pathologic acid reflux was noticed in 32.1%, 20.8%, and 35.8% during total, upright, and recumbent time, respectively. Esophageal pathologic bolus reflux was also noted in 83.0%, 77.4%, and 64.2% during total, upright, and recumbent time. Additionally, gastric acidity was found to increase with time after esophagectomy. We developed a safe, intra-thoracic anti-reflux procedure in patients undergoing trans-thoracic esophagectomy and sought to compare outcomes with those patients not undergoing intra-thoracic fundoplication (ITF).
Methods:
We queried a prospectively maintained esophageal database to identify patients who underwent esophagectomy. Intra-thoracic fundoplication was instituted in practice in 2018. GERD HRQL and Reflux Symptom Index (RSI) were administered at 6 months post-operatively. Questionnaires were retrospectively administered to 15 patients who had previously undergone robotic transthoracic esophagectomy without fundoplication and were at least 6 months post-operation. Continuous variables were compared using the Kruskal Wallis or the ANOVA tests as appropriate. Pearson’s Chi-square test was used to compare categorical variables. All statistical tests were two-sided and a p-value of <0.05 was considered statistically significant.
Results:
We identified 44 patients who underwent robotic esophagectomy and intra-thoracic fundoplication from 2018-2019 with a median age of 69 (49 – 91). There were more males (79.5%) than females (20.5%), and the mean BMI was 26.6 with an average ASA score of 3. Most of these patients had adenocarcinoma (84.1%) or squamous cell carcinoma (13.6%). Ninety percent of these patients underwent neoadjuvant therapy and 100% had an R0 resection. GERD HRQL scores in those patients who underwent ITF were 1.84 vs 11.5 in those who did not, p=0.01. The RSI scores in those who underwent ITF were 1.63 vs 13.2 in those who did not, p=0.02. Additionally, 68% of patients undergoing ITF were off proton pump inhibitors at 6 months compared to 14% in those who did not undergo ITF, p<0.001.
Conclusions:
The intra-thoracic fundoplication after esophagectomy significantly reduces reflux in this population. When compared to patients who did not undergo intra-thoracic fundoplication, this procedure resulted in better quality of life and improved reflux symptoms in esophagectomy patients.
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