Radiologic evaluation of complications after esophagogastrectomy

Area of Science:

• Radiology
• Gastroenterology
• Surgical Oncology

Background:

• Surgical stapling devices have improved esophagogastrectomy outcomes.
• Postoperative esophagogastrectomy imaging presents complex radiographic appearances.
• Prompt radiologist recognition of complications is crucial due to their potential severity.

Purpose of the Study:

• To describe the spectrum of normal postoperative esophagogastrectomy appearances on esophagrams.
• To identify and characterize common postoperative complications.
• To correlate imaging findings with specific complications.

Main Methods:

• Sixty consecutive patients undergoing esophagogastrectomy were examined with esophagrams 7 days postoperatively.
• Forty-seven procedures utilized an end-to-end anastomosis stapler.
• Follow-up examinations were conducted in 29 patients.

Main Results:

• Normal postoperative imaging findings were characterized.
• Identified complications included staple line leaks, gastric outlet obstruction, gastric necrosis, and gastric emptying issues.
• Late complications comprised benign strictures, recurrent malignancy, aspiration, reflux esophagitis, and bronchoesophageal fistula.
• Masses >1.5 cm, especially across the anastomosis, strongly correlated with recurrent malignancy.

Conclusions:

• Esophagrams are vital for evaluating postoperative esophagogastrectomy complications.
• Radiographic findings like pleural effusions and contrast extravasation indicate leaks.
• The size and location of masses on imaging are critical indicators for recurrent malignancy.