Predictive factors for refractory anastomotic stricture after cervical triangular anastomosis with gastric conduit reconstruction through the posterior mediastinum in minimally invasive esophagectomy

Abstract

Background: After esophagectomy, anastomotic strictures disturb food passage and increase the incidence of aspiration pneumonia. Multiple endoscopic balloon dilatations are required for stricture treatment. Therefore, long-term quality of life and nutritional status may be adversely affected. This study aimed to identify risk factors for strictures after cervical triangular anastomosis using a gastric conduit among patients who underwent minimally invasive esophagectomy (MIE).

Methods: A total of 188 patients who underwent MIE for esophageal cancer between 2010 and 2020 at Kobe University Hospital were retrospectively examined. The incidence of strictures, number of dilatations for stricture, and time to stricture diagnosis were evaluated. Next, the potential independent risk factor for refractory strictures requiring more than 5 endoscopic balloon dilatations was clarified.

Results: The study included 188 patients who satisfied the inclusion criteria. Anastomotic strictures were observed in 44 patients (23%). Neoadjuvant chemotherapy was significantly more common in patients with stricture than in patients without stricture (75% vs 58%, respectively; P = .041). The median number of endoscopic balloon dilatations was 5 (IQR, 1-31). Of note, 30 patients (68%) underwent their first dilatation within 3 months after MIE. In univariate and multivariate analyses, < 69 days from surgery to first endoscopic balloon dilatation was an independent risk factor for stricture requiring more than 5 endoscopic balloon dilatations after cervical triangular anastomosis in MIE (hazard ratio, 9.483; 95% CI, 2.220-54.274; P = .002).

Conclusion: Early postoperative anastomotic stricture might become refractory, and an appropriate treatment plan should be developed.

Keywords: Anastomotic stricture; Minimally invasive esophagectomy; Triangular anastomosis.