Anastomotic leak followed by late gastric conduit necrosis after minimally invasive Ivor-Lewis esophagectomy: clinical case
EAES Academy. Dobrzhanskyi O. 07/05/22; 363159; P204
CLICK HERE TO LOGIN
REGULAR CONTENT
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Introduction:
Esophageal cancer remains highly aggressive neoplasm with poor prognosis. Treatment of esophageal cancer includes combination of surgery, radiation therapy and chemotherapy. However, surgical complications are critical after esophageal resections with high morbidity and mortality rate.
Aim: The main goal of the study is to describe a clinical case of late gastric conduit necrosis after minimally invasive Ivor-Lewis procedure.
Materials and methods: A 72-year old men admitted to hospital for surgical treatment of local recurrence of squamous cell carcinoma. He received chemoradiation 1,5 years prior to admission and had radiological complete response. At the time of admission computed tomography showed a solid lesion on 33 cm of esophagus and 1 cm in diameter. Patient underwent minimally invasive Ivor-Lewis (laparoscopic and VATS) procedure with gastric tubular conduit formation. Indocyanine green (ICG) was applied to assess gastric conduit perfusion and it showed no violation in blood flow. Anastomotic leak was diagnosed on postoperative day 8. Patient was treated with local drainage and intraluminal stent placement. Patient was improving up to postoperative day 23 when gastric conduit necrosis with gastric wall perforation was diagnosed. Obstructive gastrectomy with cervical esophagostomy and feeding jejunostomy was performed. ICG was applied during surgery and no blood flow was observed in gastric conduit. However, patient got severe pleural empyema, lung abscesses, sepsis and thoracic wound infection. Patient received VAC-therapy on the thoracic wound. After infection processes was eliminated, patient underwent thoracic wound plastic with local tissues.
Results:
The patient recovered on postoperative day 112 after primary esophageal resection. 104 days were spent in intensive care unit. Histological examination showed pT1aN0M0 R0 Lv0 Pn0.
Conclusion:
Late gastric conduit necrosis is a rare complication after esophageal resection. Infectious complications are the background of prolonged hospital stay and high mortality rate. Indocyanine green may be used to assess intraoperative gastric conduit perfusion. However, prognostic value remains unclear.
Esophageal cancer remains highly aggressive neoplasm with poor prognosis. Treatment of esophageal cancer includes combination of surgery, radiation therapy and chemotherapy. However, surgical complications are critical after esophageal resections with high morbidity and mortality rate.
Aim: The main goal of the study is to describe a clinical case of late gastric conduit necrosis after minimally invasive Ivor-Lewis procedure.
Materials and methods: A 72-year old men admitted to hospital for surgical treatment of local recurrence of squamous cell carcinoma. He received chemoradiation 1,5 years prior to admission and had radiological complete response. At the time of admission computed tomography showed a solid lesion on 33 cm of esophagus and 1 cm in diameter. Patient underwent minimally invasive Ivor-Lewis (laparoscopic and VATS) procedure with gastric tubular conduit formation. Indocyanine green (ICG) was applied to assess gastric conduit perfusion and it showed no violation in blood flow. Anastomotic leak was diagnosed on postoperative day 8. Patient was treated with local drainage and intraluminal stent placement. Patient was improving up to postoperative day 23 when gastric conduit necrosis with gastric wall perforation was diagnosed. Obstructive gastrectomy with cervical esophagostomy and feeding jejunostomy was performed. ICG was applied during surgery and no blood flow was observed in gastric conduit. However, patient got severe pleural empyema, lung abscesses, sepsis and thoracic wound infection. Patient received VAC-therapy on the thoracic wound. After infection processes was eliminated, patient underwent thoracic wound plastic with local tissues.
Results:
The patient recovered on postoperative day 112 after primary esophageal resection. 104 days were spent in intensive care unit. Histological examination showed pT1aN0M0 R0 Lv0 Pn0.
Conclusion:
Late gastric conduit necrosis is a rare complication after esophageal resection. Infectious complications are the background of prolonged hospital stay and high mortality rate. Indocyanine green may be used to assess intraoperative gastric conduit perfusion. However, prognostic value remains unclear.
Introduction:
Esophageal cancer remains highly aggressive neoplasm with poor prognosis. Treatment of esophageal cancer includes combination of surgery, radiation therapy and chemotherapy. However, surgical complications are critical after esophageal resections with high morbidity and mortality rate.
Aim: The main goal of the study is to describe a clinical case of late gastric conduit necrosis after minimally invasive Ivor-Lewis procedure.
Materials and methods: A 72-year old men admitted to hospital for surgical treatment of local recurrence of squamous cell carcinoma. He received chemoradiation 1,5 years prior to admission and had radiological complete response. At the time of admission computed tomography showed a solid lesion on 33 cm of esophagus and 1 cm in diameter. Patient underwent minimally invasive Ivor-Lewis (laparoscopic and VATS) procedure with gastric tubular conduit formation. Indocyanine green (ICG) was applied to assess gastric conduit perfusion and it showed no violation in blood flow. Anastomotic leak was diagnosed on postoperative day 8. Patient was treated with local drainage and intraluminal stent placement. Patient was improving up to postoperative day 23 when gastric conduit necrosis with gastric wall perforation was diagnosed. Obstructive gastrectomy with cervical esophagostomy and feeding jejunostomy was performed. ICG was applied during surgery and no blood flow was observed in gastric conduit. However, patient got severe pleural empyema, lung abscesses, sepsis and thoracic wound infection. Patient received VAC-therapy on the thoracic wound. After infection processes was eliminated, patient underwent thoracic wound plastic with local tissues.
Results:
The patient recovered on postoperative day 112 after primary esophageal resection. 104 days were spent in intensive care unit. Histological examination showed pT1aN0M0 R0 Lv0 Pn0.
Conclusion:
Late gastric conduit necrosis is a rare complication after esophageal resection. Infectious complications are the background of prolonged hospital stay and high mortality rate. Indocyanine green may be used to assess intraoperative gastric conduit perfusion. However, prognostic value remains unclear.
Esophageal cancer remains highly aggressive neoplasm with poor prognosis. Treatment of esophageal cancer includes combination of surgery, radiation therapy and chemotherapy. However, surgical complications are critical after esophageal resections with high morbidity and mortality rate.
Aim: The main goal of the study is to describe a clinical case of late gastric conduit necrosis after minimally invasive Ivor-Lewis procedure.
Materials and methods: A 72-year old men admitted to hospital for surgical treatment of local recurrence of squamous cell carcinoma. He received chemoradiation 1,5 years prior to admission and had radiological complete response. At the time of admission computed tomography showed a solid lesion on 33 cm of esophagus and 1 cm in diameter. Patient underwent minimally invasive Ivor-Lewis (laparoscopic and VATS) procedure with gastric tubular conduit formation. Indocyanine green (ICG) was applied to assess gastric conduit perfusion and it showed no violation in blood flow. Anastomotic leak was diagnosed on postoperative day 8. Patient was treated with local drainage and intraluminal stent placement. Patient was improving up to postoperative day 23 when gastric conduit necrosis with gastric wall perforation was diagnosed. Obstructive gastrectomy with cervical esophagostomy and feeding jejunostomy was performed. ICG was applied during surgery and no blood flow was observed in gastric conduit. However, patient got severe pleural empyema, lung abscesses, sepsis and thoracic wound infection. Patient received VAC-therapy on the thoracic wound. After infection processes was eliminated, patient underwent thoracic wound plastic with local tissues.
Results:
The patient recovered on postoperative day 112 after primary esophageal resection. 104 days were spent in intensive care unit. Histological examination showed pT1aN0M0 R0 Lv0 Pn0.
Conclusion:
Late gastric conduit necrosis is a rare complication after esophageal resection. Infectious complications are the background of prolonged hospital stay and high mortality rate. Indocyanine green may be used to assess intraoperative gastric conduit perfusion. However, prognostic value remains unclear.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}