Anastomotic Stricture After Minimally Invasive Esophagectomy

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Background:

• Minimally invasive esophagectomy (MIE) improves outcomes but is linked to anastomotic strictures.
• Refractory strictures after MIE are not well understood, particularly in North America.
• Anastomotic strictures are a known complication requiring intervention.

Purpose of the Study:

• To investigate the incidence and risk factors of anastomotic strictures after MIE.
• To analyze dilation rates and outcomes in patients undergoing MIE.
• To identify factors associated with refractory anastomotic strictures post-MIE.

Main Methods:

• Retrospective review of 391 patients undergoing MIE between 2015 and 2019.
• Analysis of anastomotic dilation rates and patient-specific risk factors.
• Univariate and multivariate statistical analyses to determine associations with stricture development and dilation frequency.

Main Results:

• 34.5% of patients required 431 dilations; 3.2 dilations per patient on average.
• Three-field MIE was associated with higher dilation rates compared to 2-field MIE, but this was not significant after accounting for surgeon variability.
• Dilation within 100 days of surgery correlated with a higher need for subsequent dilations (2.0 vs 0.6 dilations/year).

Conclusions:

• A 3-field MIE approach may be associated with increased repeat dilations.
• The interval between esophagectomy and initial dilation is a critical factor for repeated interventions.
• Timely intervention is crucial to minimize repeat dilations for anastomotic strictures post-MIE.