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Surgical Prevention of Reflux after Esophagectomy for Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Reflux frequently occurs after a gastric conduit has replaced the resected esophagus. In this Swedish population-based cohort study, the potential antireflux effects of using cervical anastomosis, intrathoracic antireflux anastomosis, or pyloric drainage, and a risk of dysphagia due to cervical anastomosis and intrathoracic antireflux anastomosis were studied.

Methods

Patients undergoing esophagectomy with gastric conduit reconstruction in 2001–2005 were included. Reflux symptoms and dysphagia were assessed 6 months and 3 years postoperatively using a validated questionnaire (EORTC QLQ-OES18). The study exposures were cervical anastomosis, antireflux anastomosis, and pyloric drainage procedure. Multivariable logistic regression and propensity-adjusted analyses based on multinomial logistic regression estimated odds ratios (OR) with 95 % confidence intervals (CI), adjusted for potential confounding.

Results

A total of 304 patients were included in the study. Adjusted ORs for reflux symptoms were 0.9 (95 % CI 0.3–2.2) for patients with a cervical anastomosis compared to patients with an intrathoracic anastomosis, 0.9 (95 % CI 0.4–2.0) for patients with an antireflux anastomosis versus patients with a conventional anastomosis, and 1.5 (95 % CI 0.9–2.6) for patients after pyloric drainage versus patients without such a pyloric drainage procedure. Dysphagia was not statistically significantly increased after cervical anastomosis or antireflux anastomosis. ORs were virtually similar 3 years after surgery. No interactions were identified. The propensity analyses rendered similar results as the logistic regression models, except for a possibly increased dysphagia with a cervical anastomosis.

Conclusions

Cervical anastomosis, antireflux anastomosis, and pyloric drainage do not seem to prevent reflux symptoms 6 months or 3 years after esophagectomy for cancer with a gastric conduit.

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FUNDING

Funding was provided by the Swedish Cancer Society and the Swedish Research Council.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Maartje van der Schaaf PhD student, A. Johar BSc, MSc, P. Lagergren PhD, I. Rouvelas MD, PhD & J. Lagergren MD, PhD

  2. Division of Cancer Studies, King’s College London, London, UK

    J. Lagergren MD, PhD

  3. Department of Upper Gastrointestinal Surgery, St. Thomas’ Hospital, London, UK

    J. Gossage MD, R. Mason ChM, MD, FRCSEd & J. Lagergren MD, PhD

Authors
  1. Maartje van der Schaaf PhD student
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  2. A. Johar BSc, MSc
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  3. P. Lagergren PhD
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  4. I. Rouvelas MD, PhD
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  5. J. Gossage MD
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  6. R. Mason ChM, MD, FRCSEd
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  7. J. Lagergren MD, PhD
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Correspondence to Maartje van der Schaaf PhD student.

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van der Schaaf, M., Johar, A., Lagergren, P. et al. Surgical Prevention of Reflux after Esophagectomy for Cancer. Ann Surg Oncol 20, 3655–3661 (2013). https://doi.org/10.1245/s10434-013-3041-3

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  • DOI: https://doi.org/10.1245/s10434-013-3041-3

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