Anastomotic leakage following oesophageal reconstruction using whole stomach or distal stomach

Abstract

The stomach is the preferred organ for reconstruction after resection for carcinoma of the oesophagus and cardia. Leakage of the oesophagogastrostomy remains a main cause of morbidity and mortality after oesophagectomy. Whether the whole stomach (WS) or the distal stomach (DS) is used depends on the site of the carcinoma and any concomitant gastric pathology. Of the 428 patients who underwent resection of oesophageal and cardia carcinoma and who were reconstructed in one-stage with stomach, 17 patients (4%) had an anastomotic leak and 7 of these patients died (41%). The anastomotic leak rate was 5.2% when the distal stomach was used compared to 3.6% when the whole stomach was used, a difference that is not significant. When a stapled anastomosis was fashioned, in the distal stomach group the leakage rate was 10.6% and this was significantly higher than both a stapled anastomosis in the whole stomach group (2.5%) and a hand-sewn anastomosis in the distal stomach group (0%). Neither the nature of the resection nor the level of the anastomosis affected the incidence of leaks in any of the groups. Furthermore, the mortality rates were similar whether the leak occurred in the neck or in the chest in both groups. Attention to technical factors and appropriate selection of the type of anastomosis for oesophagogastrostomy can achieve low anastomotic leak rates after resection for cancer.