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Cervical or intrathoracic: JAMA study finds optimal location for esophagogastric anastomosis for esophagectomy

Written By : Dr Satabdi Saha |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-05-15T07:40:50+05:30  |  Updated On 15 May 2021 7:40 AM IST
Cervical or intrathoracic: JAMA study finds optimal location for  esophagogastric anastomosis for esophagectomy
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According to recent research report, intrathoracic anastomosis resulted in better outcome for patients treated with transthoracic MIE for midesophageal to distal esophageal or gastroesophageal junction cancer. The findings have been published in JAMA Surgery.

Transthoracic minimally invasive esophagectomy (MIE) is increasingly performed as part of curative multimodality treatment. In the last decade, minimally invasive esophagectomy (MIE) has been shown to be superior compared with open esophagectomy regarding postoperative outcomes, without compromising oncologic safety. Although not all surgeons are convinced of the benefits of MIE (eg, MIE has also been associated with increased complication rates in registries), it has led to many surgeons implementing transthoracic MIE with cervical anastomosis, because minimally invasive creation of an intrathoracic anastomosis is considered more challenging.

" To our knowledge, no randomized clinical trial has compared the outcome of intrathoracic anastomosis vs cervical anastomosis after transthoracic MIE. There appears to be no robust evidence on the preferred location of the anastomosis after transthoracic MIE." the research team quoted.

Researchers aimed to compare an intrathoracic with a cervical anastomosis in a randomized clinical trial. This open, multicenter randomized clinical superiority trial was performed at 9 Dutch high-volume hospitals. Patients with midesophageal to distal esophageal or gastroesophageal junction cancer planned for curative resection were included. Data collection occurred from April 2016 through February 2020.

Patients were randomly assigned (1:1) to transthoracic MIE with intrathoracic or cervical anastomosis. The primary end point was anastomotic leakage requiring endoscopic, radiologic, or surgical intervention. Secondary outcomes were overall anastomotic leak rate, other postoperative complications, length of stay, mortality, and quality of life.

Data analysis revealed some interesting facts.

  • Two hundred sixty-two patients were randomized, and 245 were eligible for analysis. Anastomotic leakage necessitating reintervention occurred in 15 of 122 patients with intrathoracic anastomosis (12.3%) and in 39 of 123 patients with cervical anastomosis (31.7%; risk difference, −19.4% [95% CI, −29.5% to −9.3%]).
  • Overall anastomotic leak rate was 12.3% in the intrathoracic anastomosis group and 34.1% in the cervical anastomosis group (risk difference, −21.9% [95% CI, −32.1% to −11.6%]).
  • Intensive care unit length of stay, mortality rates, and overall quality of life were comparable between groups, but intrathoracic anastomosis was associated with fewer severe complications (risk difference, −11.3% [−20.4% to −2.2%]), lower incidence of recurrent laryngeal nerve palsy (risk difference, −7.3% [95% CI, −12.1% to −2.5%]), and better quality of life in 3 subdomains (mean differences: dysphagia, −12.2 [95% CI, −19.6 to −4.7]; problems of choking when swallowing, −10.3 [95% CI, −16.4 to 4.2]; trouble with talking, −15.3 [95% CI, −22.9 to −7.7]).

"Future research will be needed to evaluate to what extent broad implementation of transthoracic MIE with intrathoracic anastomosis will lead to improved patient outcomes and assess long-term functional and oncological outcome between patients with intrathoracic and cervical anastomosis after transthoracic MIE."the team concluded.

For full article follow the link: 10.1001/jamasurg.2021.1555

Primary source: JAMA Surgery


JAMA Surgeryintrathoracic anastomosistransthoracic MIEoesophageal cancer
Source : JAMA Surgery
Dr Satabdi Saha
Dr Satabdi Saha

    Dr Satabdi Saha (BDS, MDS) is a practicing pediatric dentist with a keen interest in new medical researches and updates. She has completed her BDS from North Bengal Dental College ,Darjeeling. Then she went on to secure an ALL INDIA NEET PG rank and completed her MDS from the first dental college in the country – Dr R. Ahmed Dental College and Hospital. She is currently attached to The Marwari Relief Society Hospital as a consultant along with private practice of 2 years. She has published scientific papers in national and international journals. Her strong passion of sharing knowledge with the medical fraternity has motivated her to be a part of Medical Dialogues.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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