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European Journal of Cardio-Thoracic Surgery, Vol 6, 79-84, Copyright © 1992 by European Association for Cardio-thoracic Surgery

ARTICLES

Early and late functional results in patients with intrathoracic gastric replacement after oesophagectomy for carcinoma

P De Leyn, W Coosemans and T Lerut
Division of Thoracic Surgery, Catholic University of Leuven, Belgium.

The function of the gastric substitute after oesophagectomy for carcinoma was studied retrospectively in 80 patients. At 3 months and 1 year postoperatively, a clinical and endoscopical examination was performed. A modified Visick grading of the results was used for scoring the final result. At 3 months 90% of the patients lost weight, compared with their preoperative status. At 1 year postoperatively, however, only 10% of the patients noted a further weight loss. One- fourth of the patients suffered 3 months postprandial fullness and diarrhoea, while 18% had dumping symptoms. These symptoms are mostly temporarily and disappear almost completely at 1 year. Three months postoperatively, 27% of patients had dysphagia, and 15% had heartburn and/or regurgitation. At 1 year, heartburn and/or regurgitation were increasingly reported (up to 21%), while less dysphagia was noted (15%). Early stricture requiring one or more dilatations was present in 18.7% of the patients. Five patients developed a late anastomotic stricture; 4 were located at the level of the intrathoracic anastomosis and were associated with severe oesophagitis. At 1 year there was a statistically significant difference between patients with cervical anastomosis and those with intrathoracic anastomosis when comparing reflux symptoms (4% vs. 50%; p = 0.0001) and oesophagitis (8% vs. 53%; p = 0.001). In all, 86% of patients had an excellent or very good late functional result, but only 6% of patients who underwent cervical anastomosis have a Visick score 3 or 4 vs. 23% after intrathoracic anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)

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