Universität zu Köln

Schroeder, Wolfgang, Raptis, Dimitri A., Schmidt, Henner M., Gisbertz, Suzanne S., Moons, Johnny ORCID: 0000-0003-4553-3102, Asti, Emanuele, Luyer, Misha D. P., Hoelscher, Arnulf H., Schneider, Paul M., Henegouwen, Mark I. van Berge, Nafteux, Philippe, Nilsson, Magnus, Raesanen, Jari, Palazzo, Francesco, Mercer, Stuart, Bonavina, Luigi, Nieuwenhuijzen, Grard A. P., Wijjnhoven, Bas P. L., Pattyn, Piet, Grimminger, Peter P., Bruns, Christiane J. and Gutschow, Christian A. (2019). Anastomotic Techniques and Associated Morbidity in Total Minimally Invasive Transthoracic Esophagectomy Results From the EsoBenchmark Database. Ann. Surg., 270 (5). S. 820 - 827. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1528-1140

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Abstract

Objective: The aim of this study was to describe anastomotic techniques used for total minimally invasive transthoracic esophagectomy (ttMIE) and to analyze the associated morbidity. Background: ttMIE faces increasing application in surgical treatment of esophageal cancer. For esophagogastric reconstruction, different anastomotic techniques are currently used, but their effect on postoperative anastomotic leakage and morbidity has not been investigated. Patients and Methods: Patients were selected from a basic dataset, collected during a 5-year period from 13 international surgical high-volume centers. Endpoints were anastomotic leakage rate and postoperative morbidity in correlation to anastomotic techniques, measured by the Clavien-Dindo classification and the Comprehensive Complication Index (CCI). Results: Five anastomotic techniques were identified in 966 patients after ttMIE: intrathoracic end-to-side circular-stapled technique in 427 patients (double-stapling n = 90, purse-string n = 337), intrathoracic (n = 109) or cervical (n = 255) side-to-side linear-stapled, and cervical end-to-side handsewn (n = 175). Leakage rates were similar in intrathoracic and cervical anastomoses (15.9% vs 17.2%, P = 0.601), but overall complications (56.7%% vs 63.7%, P = 0.029) and median 90-day CCI {21 [interquartile range (IQR) 0-36] vs 29 [IQR 0-40], P = 0.019} favored intrathoracic reconstructions. Leakage rates after intrathoracic end-to-side double-stapling (23.3%) and cervical end-to-side hand-sewn (25.1%) techniques were significantly higher compared with intrathoracic side-to-side linear (15.6%), end-to-side purse-string (13.9%), and cervical side-to-side linear-stapled esophagogastrostomies (11.8%) (P < 0.001). Multivariable analysis confirmed anastomotic technique as independent predictor of leakage after ttMIE. Conclusion: Results of this analysis present the current status of the technical evolution of ttMIE with anastomotic leakage as predominant surgical complication. However, technique-related morbidity requires cautious interpretation considering the long learning curve of this complex surgical procedure.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schroeder, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Raptis, Dimitri A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Henner M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gisbertz, Suzanne S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Moons, Johnny UNSPECIFIED orcid.org/0000-0003-4553-3102 UNSPECIFIED Asti, Emanuele UNSPECIFIED UNSPECIFIED UNSPECIFIED Luyer, Misha D. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelscher, Arnulf H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Paul M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Henegouwen, Mark I. van Berge UNSPECIFIED UNSPECIFIED UNSPECIFIED Nafteux, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Nilsson, Magnus UNSPECIFIED UNSPECIFIED UNSPECIFIED Raesanen, Jari UNSPECIFIED UNSPECIFIED UNSPECIFIED Palazzo, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Mercer, Stuart UNSPECIFIED UNSPECIFIED UNSPECIFIED Bonavina, Luigi UNSPECIFIED UNSPECIFIED UNSPECIFIED Nieuwenhuijzen, Grard A. P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wijjnhoven, Bas P. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pattyn, Piet UNSPECIFIED UNSPECIFIED UNSPECIFIED Grimminger, Peter P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, Christiane J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gutschow, Christian A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-128711
DOI:	10.1097/SLA.0000000000003538
Journal or Publication Title:	Ann. Surg.
Volume:	270
Number:	5
Page Range:	S. 820 - 827
Date:	2019
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1528-1140
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CANCER; COMPLICATIONS; SURVIVAL; OUTCOMES; MULTICENTER; RESECTION; IMPACT Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12871