RESUMO
BACKGROUND: Despite improved outcomes, minimally invasive esophagectomy (MIE) continues to be associated with anastomotic strictures. Most resolve after a single dilation; however, some become refractory. Little is known about strictures after MIE in North America. METHODS: We performed a single-institution retrospective review of MIEs from 2015 to 2019. Primary outcomes were the proportion of patients requiring anastomotic dilation and the dilation rate per year. Univariate analyses of patients undergoing dilation by various risk factors were performed with nonparametric tests, and multivariate analyses of the dilation rate were conducted using generalized linear models. RESULTS: Of 391 included patients, 431 dilations were performed on 135 patients (34.5%, 3.2 dilations per patient who required at least 1 per patient). One complication occurred after dilation. Comorbidities, tumor histology, and tumor stage were not significantly associated with stricture. Three-field MIE was associated with a higher percentage of patients undergoing dilation (48.9% vs 27.1%, P < .001) and a higher rate of dilations (0.944 vs 0.441 dilations per year, P = .007) than 2-field MIE, and this association remained significant after controlling for covariates. When accounting for surgeon variability, this difference was no longer significant. Among patients with 1 or more dilations, those receiving dilation within 100 days of surgery needed more subsequent dilations (2.0 vs 0.6 dilations per year, P < .001). CONCLUSIONS: After controlling for multiple variables, a 3-field MIE approach was associated with a higher rate of repeat dilations in patients undergoing MIE. A shorter interval between esophagectomy and initial dilation is strongly associated with the need for repeated dilations.
Assuntos
Neoplasias Esofágicas , Estenose Esofágica , Humanos , Constrição Patológica/cirurgia , Estenose Esofágica/epidemiologia , Estenose Esofágica/etiologia , Estenose Esofágica/cirurgia , Esofagectomia/efeitos adversos , Resultado do Tratamento , Anastomose Cirúrgica/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Neoplasias Esofágicas/complicaçõesRESUMO
Due to the limited exposure, technical challenges, and postoperative pain of thoracic spine surgery, open thoracotomy and video-assisted thoracic surgery (VATS) are associated with significant morbidity and mortality. The modified French-window thoracotomy approach with the aid of a thoracoscope is a useful technique for approaching diseases of the anterior spinal. This approach allows for specific exposure of the spine with a reduction in postoperative pain, morbidity, and mortality and avoids the limitations of VATS.