The University of Southampton
University of Southampton Institutional Repository

Hiatal hernia after esophagectomy for cancer

Hiatal hernia after esophagectomy for cancer
Hiatal hernia after esophagectomy for cancer

BACKGROUND: Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE).

METHODS: The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH.

RESULTS: Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p = 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p < 0.001). In-hospital deaths were solely seen after emergency operations (19%).

CONCLUSIONS: HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.

Aged, Analysis of Variance, Combined Modality Therapy, Esophageal Neoplasms, Esophagectomy, Female, Follow-Up Studies, Hernia, Hiatal, Humans, Logistic Models, Male, Middle Aged, Minimally Invasive Surgical Procedures, Postoperative Complications, Risk Factors, Tomography, X-Ray Computed, Journal Article
0003-4975
1055-1062
Brenkman, Hylke J.F.
50b3cc6b-d7e2-4222-ac97-87b2dd90b480
Parry, Kevin
a7c94e42-a76b-44ac-a2d9-fb37c80a8454
Noble, Fergus
4f14574c-28f2-4e04-bd95-f53c7649e1fa
van Hillegersberg, Richard
3fe89d0f-bad1-435f-80cf-3107ec2fe43c
Sharland, Donna
b9b42e9d-8ad2-4bb0-bd98-32dccfa2ad2a
Goense, Lucas
d6049a3d-73d1-4c89-87ab-58dbcf68e6c7
Kelly, Jamie
c8b841fe-7134-4332-b453-5dc8c76058a5
Byrne, James P.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Underwood, Timothy J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Ruurda, Jelle P.
765bb99b-a913-4c79-8ec4-949d68805bc9
Brenkman, Hylke J.F.
50b3cc6b-d7e2-4222-ac97-87b2dd90b480
Parry, Kevin
a7c94e42-a76b-44ac-a2d9-fb37c80a8454
Noble, Fergus
4f14574c-28f2-4e04-bd95-f53c7649e1fa
van Hillegersberg, Richard
3fe89d0f-bad1-435f-80cf-3107ec2fe43c
Sharland, Donna
b9b42e9d-8ad2-4bb0-bd98-32dccfa2ad2a
Goense, Lucas
d6049a3d-73d1-4c89-87ab-58dbcf68e6c7
Kelly, Jamie
c8b841fe-7134-4332-b453-5dc8c76058a5
Byrne, James P.
e3d5b8fe-1b69-441c-a173-e084fe5372a6
Underwood, Timothy J.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Ruurda, Jelle P.
765bb99b-a913-4c79-8ec4-949d68805bc9

Brenkman, Hylke J.F., Parry, Kevin, Noble, Fergus, van Hillegersberg, Richard, Sharland, Donna, Goense, Lucas, Kelly, Jamie, Byrne, James P., Underwood, Timothy J. and Ruurda, Jelle P. (2017) Hiatal hernia after esophagectomy for cancer. The Annals of Thoracic Surgery, 103 (4), 1055-1062. (doi:10.1016/j.athoracsur.2017.01.026).

Record type: Article

Abstract

BACKGROUND: Hiatal hernia (HH) after esophagectomy is becoming more relevant due to improvements in survival. This study evaluated and compared the occurrence and clinical course of HH after open and minimally invasive esophagectomy (MIE).

METHODS: The prospectively recorded characteristics of patients treated with esophagectomy for cancer at 2 tertiary referral centers in the United Kingdom and the Netherlands between 2000 and 2014 were reviewed. Computed tomography reports were reviewed to identify HH.

RESULTS: Of 657 patients, MIE was performed in 432 patients (66%) and open esophagectomy in 225 (34%). A computed tomography scan was performed in 488 patients (74%). HH was diagnosed in 45 patients after a median of 20 months (range, 0 to 101 months). The development of HH after MIE was comparable to the open approach (8% vs 5%, p = 0.267). At the time of diagnosis, 14 patients presented as a surgical emergency. Of the remaining 31 patients, 17 were symptomatic and 14 were asymptomatic. An elective operation was performed in 10 symptomatic patients, and all others were treated conservatively. During conservative treatment, 2 patients presented as a surgical emergency. An emergency operation resulted in a prolonged intensive care unit stay compared with an elective procedure (3 vs 0 days, p < 0.001). In-hospital deaths were solely seen after emergency operations (19%).

CONCLUSIONS: HH is a significant long-term complication after esophagectomy, occurring in a substantial proportion of the patients. The occurrence of HH after MIE and open esophagectomy is comparable. Emergency operation is associated with dismal outcomes and should be avoided.

Full text not available from this repository.

More information

Accepted/In Press date: 5 January 2017
e-pub ahead of print date: 6 March 2017
Published date: April 2017
Additional Information: Copyright © 2017. Published by Elsevier Inc.
Keywords: Aged, Analysis of Variance, Combined Modality Therapy, Esophageal Neoplasms, Esophagectomy, Female, Follow-Up Studies, Hernia, Hiatal, Humans, Logistic Models, Male, Middle Aged, Minimally Invasive Surgical Procedures, Postoperative Complications, Risk Factors, Tomography, X-Ray Computed, Journal Article

Identifiers

Local EPrints ID: 416792
URI: https://eprints.soton.ac.uk/id/eprint/416792
ISSN: 0003-4975
PURE UUID: bab05c24-30ab-42af-84b1-76e381db2019
ORCID for Timothy J. Underwood: ORCID iD orcid.org/0000-0001-9455-2188

Catalogue record

Date deposited: 10 Jan 2018 17:30
Last modified: 15 Aug 2019 00:45

Export record

Altmetrics

Contributors

Author: Hylke J.F. Brenkman
Author: Kevin Parry
Author: Fergus Noble
Author: Richard van Hillegersberg
Author: Donna Sharland
Author: Lucas Goense
Author: Jamie Kelly
Author: James P. Byrne
Author: Jelle P. Ruurda

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×