Original Article
The Application of Two-Stage Operation for High-Risk Patients with Oesophageal Cancer Following Gastrectomy

https://doi.org/10.1007/s11605-022-05414-wGet rights and content

Abstract

Background

Oesophageal replacement by colonic interposition remains a major challenge due to its complexity and high incidence of complications; here we applied the two-stage operation strategy to oesophageal replacement by colonic interposition in high-risk oesophageal cancer patients following gastrectomy.

Methods

We performed a retrospective analysis on the data of patients with a history of distal gastrectomy who underwent one-stage and two-stage oesophageal replacement by colonic interposition from February 2012 to February 2020, and explored the relationship between the staging strategy and postoperative outcomes.

Results

The clinical data of 93 patients were collected and analysed. There were no significant differences in the patients’ characteristics between the two groups (all p > 0.05), except for comorbidities and Charlson Comorbidity Index (all p < 0.05). The Clavien–Dindo score between the two groups was also not significantly different (p > 0.05). The logistic regression models revealed that patients who had received preoperative therapy had a higher Clavien–Dindo score (p < 0.05), but the stage strategy did not (p > 0.05).

Conclusions

The two-stage operation is feasible in high-risk patients who need to undergo colonic interposition for oesophageal replacement. At the same time, it lowers the technical threshold of colonic interposition for oesophageal replacement, increasing this surgical technique’s acceptability.

Introduction

With the improvement in the survival rate of patients after gastrectomy, the change in patients’ dietary habits postgastrectomy and the gradual increase in oesophageal reflux disease, an increasing number of patients following gastrectomy develop oesophageal cancer.1,2 This means that more patients with a history of gastrectomy will need oesophageal replacement by colonic interposition because the stomach can no longer serve as a substitute for the oesophagus, despite its simplicity and reliability.3 However, oesophageal replacement by colonic interposition is famous for its complex procedure, specific perioperative management and increased complications and is associated with extremely high mortality and morbidity rates.4., 5., 6. For patients with high-risk factors who undergo colonic interposition for oesophageal replacement, the risk may be higher.

To reduce surgical mortality and morbidity rates, staged surgery has been used for radical oesophagectomy.7 Here, we applied the two-stage operation strategy to oesophageal replacement by colonic interposition in high-risk oesophageal cancer patients following gastrectomy to investigate whether the two-stage operation is feasible and explore the relationship between staging strategy and postoperative outcomes.

Section snippets

Patients and Methods

We performed a retrospective analysis at the Department of Thoracic Surgery, Renmin Hospital of Wuhan University, China, from February 2012 to February 2020. During this period, all oesophageal replacement by colonic interposition surgeries were performed by one surgeon as the chief operator. The clinical data of oesophageal cancer patients with a history of gastrectomy who underwent oesophageal replacement by colonic interposition were collected and analysed. The two-stage operation indicated

Results

Finally, the clinical data of 93 patients were collected and analysed. The two-stage operation was completed in 28 cases and one-stage in 65 cases. Among the 93 patients, 3 underwent a two-stage operation because of tight abdominal adhesions during the operation; one underwent a two-stage operation because of the dense adhesion of the oesophageal tumour to the surrounding tissue.

Seven patients were excluded from this study. Four were excluded for failing to complete the second stage of surgery

Discussion

Higher complication rates are often associated with higher mortality. The main causes of in-hospital deaths in oesophageal cancer surgery are pulmonary complications, cardiac comorbidity, renal failure and anastomotic leakage.12,13 Masaki Ohi and his colleagues’ study revealed that advanced age, number of removed lymph nodes and chronic obstructive pulmonary disease (COPD) were risk factors for pulmonary complications.14 A study from China reported that alcohol consumption was also associated

Conclusion

The two-stage operation is feasible in high-risk patients who need to undergo colonic interposition for oesophageal replacement. It can relatively reduce surgical complications and the difficulty of postoperative management and give more patients the opportunity for surgery. At the same time, it lowers the technical threshold of colonic interposition for oesophageal replacement, increasing this surgical technique’s acceptability.

Conflict of Interest

The authors declare no competing interests.

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Gao-li Liu, Xin Wang and Hai-feng Hu contributed equally to this work.

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