Postoperative Functional Result and Quality of Life after Oesophageal Reconstruction Based on the Type of Cervical Anastomosis
I. Predescu, D. Predescu, S. ConstantinoiuOriginal article, no. 2, 2015
Introduction. The keystone of the rate of postoperative complicationsand functional outcome in oesophageal reconstructionis the technique method of performing cervical anastomosis.Despite new technologies and improved technique inspecialized centres, post-anastomosis complications have notsignificantly improved.Purpose: The goal of our study is to analyse the causes that make anastomosis with the oesophagus hypopharynx a particularcase. If anatomical and morphological aspects cannot beadjusted (poor histological structure and vascularity etc.), someimportant elements for performing a good anastomosis can beidentified and corrected.Material and Method: Between 1981-2014, 195 oesophagealreconstructions were performed in our clinic. Our studyinvolved an analysis of 72 cases (2000-2014), based on a statisticalevaluation by Kaplan-Meier method that considered aseries of factors (oesophagus hypopharynx as anastomoticpartner, stomach, jejuno-ileum, colon as visceral partner,pharyngotomy type, T-L, T-T, L-L, L-T type anastomosis,number of anastomotic layers). Results were compared withthose obtained by standard clinical and laboratory investigation,analysing the post-therapeutic outcome using threecriteria (clinical aspects of swallowing, barium swallow andendoscopy) and by subjective assessment by each patient ofhis her state and complaints, with effects on long-termfunctional outcome (dysphagia, reflux, pain, asthenia, weightloss, hoarseness).Results: Statistical analysis determined that only some of theanalysed factors proved to be valuable. The higher the level ofthe anastomosis, the more intense the impairment of thedigestive function. The jejunum and left colon proved to bemost effective anastomotic partners. The best method forimplantation seems to be T-T or T-L and the number ofanastomosis layers has no influence on postoperative outcome.Conclusions: Acquired data can influence to some extent theoperatory technique, with a lower complication rate.Unfortunately, laborious technical aspects and specificanatomical limitations make this goal difficult to achieve.
