Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 1;18(1):13.
doi: 10.1186/s12893-018-0347-x.

Pylorus drainage procedures in thoracoabdominal esophagectomy - a single-center experience and review of the literature

Stefan Fritz  1 , Katharina Feilhauer  2 , André Schaudt  2 , Hansjörg Killguss  2 , Eduard Esianu  2 , René Hennig  2 , Jörg Köninger  2
Affiliations

Pylorus drainage procedures in thoracoabdominal esophagectomy - a single-center experience and review of the literature

Stefan Fritz et al. BMC Surg. .

Abstract

Background: Pylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Currently, controversy remains regarding the need for these practices. The present study aimed to determine the value and role of pyloric drainage procedures in esophagectomy with gastric replacement.

Methods: A retrospective review of prospectively collected data was performed for all consecutive patients who underwent thoracoabdominal resection of the esophagus between January 2009 and December 2016 at the Katharinenhospital in Stuttgart, Germany. Clinicopathologic features and surgical outcomes were evaluated with a focus on postoperative nutrition and gastric emptying.

Results: The study group included 170 patients who underwent thoracoabdominal esophageal resection with a gastric conduit using the Ivor Lewis approach. The median age of the patients was 64 years. Most patients were male (81%), and most suffered from adenocarcinoma of the esophagus (75%). The median hospital stay was 20 days, and the 30-day hospital death rate was 2.9%. According to the department standard, pylorotomy, pyloroplasty, or other pyloric drainage procedures were not performed in any of the patients. Overall, 28/170 patients showed clinical signs of DGE (16.5%).

Conclusions: In the literature, the rate of DGE after thoracoabdominal esophagectomy is reported to be approximately 15%, even with the use of pyloric drainage procedures. This rate is comparable to that reported in the present series in which no pyloric drainage procedures were performed. Therefore, we believe that pyloric drainage procedures may be unwarranted in thoracoabdominal esophagectomy. However, future randomized trials are needed to ultimately confirm this supposition.

Keywords: Delayed gastric emptying; Pyloroplasty; Pylorotomy; Pylorus drainage; Thoracoabdominal esophagectomy.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The present study was approved by the institutional review board of the Klinikum Stuttgart and is in compliance with the Declaration of Helsinki. The study was designed as an observational retrospective analysis and therefore did not influence the therapy in any way.

Consent for publication

The present manuscript does not contain any individual’s data in any form.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Gastric conduit for esophageal replacement All patients received thoracoabdominal esophagectomy with gastric pull-up. The gastric conduit was small, with a diameter of 3–5 cm. None of the patients received any pyloric drainage procedure such as pylorotomy, pyloroplasty, pylorus buginage or botulinum toxin injection.
See this image and copyright information in PMC

References

    1. Earlam R, Cunha-Melo JR. Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg. 1980;67(6):381–390. doi: 10.1002/bjs.1800670602. - DOI - PubMed
    1. Muller JM, Erasmi H, Stelzner M, et al. Surgical therapy of oesophageal carcinoma. Br J Surg. 1990;77(8):845–857. doi: 10.1002/bjs.1800770804. - DOI - PubMed
    1. Raymond DP, Seder CW, Wright CD, et al. Predictors of major morbidity or mortality after resection for esophageal cancer: a Society of Thoracic Surgeons general thoracic surgery database risk adjustment model. Ann Thorac Surg. 2016;102(1):207–214. doi: 10.1016/j.athoracsur.2016.04.055. - DOI - PMC - PubMed
    1. Whooley BP, Law S, Murthy SC, et al. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001;233(3):338–344. doi: 10.1097/00000658-200103000-00006. - DOI - PMC - PubMed
    1. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–2084. doi: 10.1056/NEJMoa1112088. - DOI - PubMed