Robert D Andres, MD, PhD, Valerie Wu Chao Ying, MD, Jose M Martinez, MD, FACS. University of Miami – Miller School of Medicine / Jackson Memorial Hospital
INTRODUCTION: Esophageal anastomotic stricture is a well described complication after transhiatal esophagectomy (THE). We have recently examined the management and provided treatment recommendations after the initial endoscopic therapy for esophageal stricture after THE. Here we expand upon those findings examining the effects of cancer stage, neoadjuvant treatment and post operative complications on esophageal dilations.
METHODS: We performed a retrospective review of one surgeon’s experience with esophageal dilations after THE between 2009 – 2013. Patient demographics: n = 43, age = 59, 95% male, 5% female. Patients with T3 lesions and/or node positive received either neoadjuvant chemotherapy or chemoradiation and restaged prior to surgical intervention. Two surgeons performed THE, either thru an open or laparoscopic approach, and one surgeon performed all endoscopic therapies.
RESULTS: For all cases, average: number of dilations, time since surgery, time since first dilation and time between each dilation was: 3.67, 313 days, 197 days and 44 days, respectively. The effect of neoadjuvant therapy was evaluated. No neoadjuvant vs neoadjuvant therapy: number of dilations: 3.50 vs 3.88; time since surgery: 282 vs 343 days; time since first dilation: 189 vs 211 days; and time between each dilation: 39 vs 61 days. Post operative complications requiring intervention (eg wound infection/drainage, abscess, fistula) were also evaluated: number of dilations: 2.96 vs 5.07; time since first surgery: 270 vs 416 days; time since first dilation: 143 vs 318 days; and time between each dilation: 42 vs 77 days. For all cases, the time between the penultimate and final dilation was 105 days. For those patients undergoing multiple dilations (>3), the time between the penultimate and final dilation was 171 days. Additionally, for those receiving >3, there was no discernable difference in the number of days of between each dilation for those receiving neoadjuvant chemotherapy compared to those with post operative complications.
CONCLUSION(S): Our results demonstrate that patient’s with higher stages of esophageal cancer who receive neoadjuvant modalities require more frequent dilations and a longer course of endoscopic management. Furthermore, a post operative complication after a THE, regardless of the cancer staging or neoadjuvant course, on average will double the number of dilations and total time of therapy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80365
Program Number: P340
Presentation Session: Poster (Non CME)
Presentation Type: Poster