Our Summary

This study is challenging the existing idea that leaks from a certain type of surgery connecting the esophagus to the stomach (anastomosis) in the chest area are more dangerous and deadly than similar leaks that occur in the neck area. The researchers believe that the location of the anastomosis doesn’t really matter when it comes to death rates.

To test this, they looked at a whole lot of studies (from 2000 to 2015) comparing the two types of surgeries, one done through the chest (TTE) and the other through the hiatus, an opening in the diaphragm (THE). They didn’t consider cases where part of the intestine or colon was used.

They looked at how often leaks occurred, how often these leaks led to death, the overall death rate within 30 days of surgery, and the overall rate of complications. They used a certain type of statistical analysis for the studies that reported leak rates for both types of surgeries.

They ended up analyzing 21 studies, which included 7167 patients. The TTE approach had a lower leak rate compared to THE, and there was no significant difference in the death rates linked to these leaks. The overall death rate within 30 days of surgery and the overall rate of complications were also not different between the two types of surgeries.

In conclusion, the TTE approach has a lower leak rate and doesn’t lead to higher death rates or complications compared to THE. The study suggests that the previous belief about higher death rates from TTE leaks is exaggerated. Therefore, the choice between the chest or neck approach can be based on the surgeon’s judgment and other factors.

FAQs

  1. What is the difference in leak rates between transthoracic and transhiatal esophagectomies?
  2. Is there a significant difference in mortality based on the location of the esophagogastric anastomosis?
  3. Does the transthoracic esophagectomy approach result in higher morbidity or mortality than the transhiatal approach?

Doctor’s Tip

A helpful tip a doctor might tell a patient about esophagectomy is to follow post-operative care instructions closely, including taking prescribed medications, avoiding heavy lifting or strenuous activities, and attending follow-up appointments. It is also important to maintain a healthy diet and avoid smoking to promote healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended esophagectomy include those with esophageal cancer, Barrett’s esophagus with high-grade dysplasia, and refractory benign esophageal strictures. The decision to undergo esophagectomy is usually made after considering the patient’s overall health, the stage of the disease, and the potential benefits and risks of the surgery.

Timeline

Before esophagectomy:

  1. Patient undergoes pre-operative evaluations such as imaging studies, blood tests, and consultations with various specialists.
  2. Patient may undergo neoadjuvant chemotherapy or radiation therapy to shrink the tumor and improve surgical outcomes.
  3. Patient is admitted to the hospital and undergoes the esophagectomy procedure, which involves removing a portion of the esophagus and reconstructing it.
  4. Post-operatively, the patient is closely monitored in the intensive care unit for potential complications such as leakage, infection, or respiratory issues.

After esophagectomy:

  1. Patient is gradually weaned off mechanical ventilation and pain medication.
  2. Patient begins oral intake slowly and may require a feeding tube initially.
  3. Patient undergoes physical therapy to regain strength and mobility.
  4. Patient is discharged from the hospital and continues to follow up with their healthcare team for monitoring and potential adjuvant treatments.
  5. Patient may experience long-term side effects such as difficulty swallowing, reflux, or nutritional deficiencies that require ongoing management.

What to Ask Your Doctor

  1. What is the difference between transthoracic esophagectomy (TTE) and transhiatal esophagectomy (THE)?
  2. What are the potential risks and benefits of each approach?
  3. What is the anastomotic leak rate for each approach?
  4. Is there a difference in leak-associated mortality between TTE and THE?
  5. What is the overall 30-day mortality rate for each approach?
  6. What is the overall morbidity rate for each approach?
  7. How will the choice of thoracic versus cervical anastomosis be determined for my specific case?
  8. Are there any specific factors that may influence the decision between TTE and THE for my surgery?
  9. What is the expected recovery time and post-operative care for each approach?
  10. Are there any alternative surgical options or techniques that should be considered?

Reference

Authors: Ryan CE, Paniccia A, Meguid RA, McCarter MD. Journal: Ann Surg Oncol. 2017 Jan;24(1):281-290. doi: 10.1245/s10434-016-5417-7. Epub 2016 Jul 12. PMID: 27406098