Universität zu Köln

Fuchs, Hans F., Broderick, Ryan C., Harnsberger, Cristina R., Divo, Francisco Alvarez, Coker, Alisa M., Jacobsen, Garth R., Sandler, Bryan J., Bouvet, Michael and Horgan, Santiago (2016). Intraoperative Endoscopic Botox Injection During Total Esophagectomy Prevents the Need for Pyloromyotomy or Dilatation. J. Laparoendosc. Adv. Surg. Tech., 26 (6). S. 433 - 439. NEW ROCHELLE: MARY ANN LIEBERT, INC. ISSN 1557-9034

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Abstract

Background: Esophagectomy may lead to impairment in gastric emptying unless pyloric drainage is performed. Pyloric drainage may be technically challenging during minimally invasive esophagectomy and can add morbidity. We sought to determine the effectiveness of intraoperative endoscopic injection of botulinum toxin into the pylorus during robotic-assisted esophagectomy as an alternative to surgical pyloric drainage. Materials and Methods: We performed a retrospective analysis of patients with adenocarcinoma and squamous cell carcinoma of the distal esophagus or gastroesophageal junction who underwent robotic-assisted transhiatal esophagectomy (RATE) without any surgical pyloric drainage. Patients with and without intraoperative endoscopic injection of 200 units of botulinum toxin in 10 cc of saline (BOTOX group) were compared to those that did not receive any pyloric drainage (noBOTOX group). Main outcome measure was the incidence of postoperative pyloric stenosis; secondary outcomes included operative and oncologic parameters, length of stay (LOS), morbidity, and mortality. Results: From November 2006 to August 2014, 41 patients (6 females) with a mean age of 65 years underwent RATE without surgical drainage of the pylorus. There were 14 patients in the BOTOX group and 27 patients in the noBOTOX group. Mean operative time was not different between the comparison groups. There was one conversion to open surgery in the BOTOX group. No pyloric dysfunction occurred in the BOTOX group postoperatively, and eight stenoses in the noBOTOX group (30%) required endoscopic therapy (P<.05). There were no differences in incidence of anastomotic strictures or anastomotic leaks. One patient in group noBOTOX required pyloroplasty 3 months after esophagectomy. There was one death in the noBOTOX group postoperatively (30-day mortality 2.4%). Mean LOS was 9.6 days, and BOTOX patients were discharged earlier (7.4 versus 10.7, P<.05). Conclusion: Intraoperative endoscopic injection of botulinum toxin into the pylorus during RATE is feasible, safe, and effective and can prevent the need for pyloromyotomy.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fuchs, Hans F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Broderick, Ryan C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Harnsberger, Cristina R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Divo, Francisco Alvarez UNSPECIFIED UNSPECIFIED UNSPECIFIED Coker, Alisa M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jacobsen, Garth R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sandler, Bryan J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouvet, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Horgan, Santiago UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-273870
DOI:	10.1089/lap.2015.0575
Journal or Publication Title:	J. Laparoendosc. Adv. Surg. Tech.
Volume:	26
Number:	6
Page Range:	S. 433 - 439
Date:	2016
Publisher:	MARY ANN LIEBERT, INC
Place of Publication:	NEW ROCHELLE
ISSN:	1557-9034
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MINIMALLY INVASIVE ESOPHAGECTOMY; ASSISTED TRANSHIATAL ESOPHAGECTOMY; PYLORIC DRAINAGE; CANCER; ESOPHAGUS; ADENOCARCINOMA; CARCINOMA; RESECTION; OUTCOMES; LYMPHADENECTOMY Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27387