Fístula cervical postesofagectomía: diagnóstico y tratamiento / Cervical anastomotic leak after esophagectomy: Diagnosis and management

Introducción Los tumores del estroma gastrointestinal (GIST) representan el 2% de los tumores digestivos. La cirugía constituye el único método curativo en los casos localizados. El abordaje laparoscópico se ha extendido en los últimos años. Presentamos nuestra experiencia en el tratamiento de los GIST. Material y métodos Entre 1997 y 2010 se ha intervenido con intención curativa a 40 pacientes de un total de 45 diagnosticados de GIST. Recogimos prospectivamente datos referentes a: características demográficas, localización y biología tumoral, diagnóstico, tipo de cirugía y resultados de la misma. Resultados Se trataba de 24 varones y 16 mujeres con una edad media de 66,7 años. La localización fue gástrica en 24 casos (60%), en el intestino delgado 13 (32,5%), en el colon 2 (5%) y en el esófago 1 (2,5%). Fueron intervenidos por laparotomía 27 casos, 12 mediante laparoscopia (1 toracoscopia) y 1 resección endoscópica en tumor de sigma. Tras una mediana de seguimiento de 31 meses (2-120) han recidivado 4 casos (10%) todos tras laparotomía. Dos pacientes del grupo de laparotomía han fallecido por la neoplasia. Tras el estudio univariante los factores pronósticos para la RL fueron: tamaño tumoral (p=0,0001), número de mitosis (p=0,001), tratarse de un tumor localmente avanzado (p=0,01) y la rotura tumoral (p=0,002). Tras el estudio multivariante solo permanece el tamaño (p=0,029; RR 1,363; IC 95% 1,033-1,799). Para la supervivencia, tras el estudio univariante, se muestra significativa la presencia de tumor localmente avanzado, mientras que ningún factor se muestra significativo tras el estudio multivariante (AU)

Introduction Gastrointestinal stromal tumours (GIST) make up 2% of gastrointestinal tumours. Surgery is the only treatment method in localised cases. The laparoscopic approach has increased over the last few years. We present our experience in the treatment of GIST. Material and methods A total of 40 patients with 45 GIST had been subjected to surgical treatment between 1997 and 2010. Data was retrospectively collected on, demographic characteristics, location and tumour biology, diagnosis, type of surgery and the results of that surgery. Results A total of 24 males and 16 women, with a mean age of 66.7 years, were treated. The location was gastric in 24 cases (60%), small intestine in 13 (32.5%), colon in 2 (5%) and oesophagus in 1 case (2.5%). Laparotomy was performed in 27 cases, 12 by laparoscopy (1 thoracoscopy), and 1 endoscopic sigmoid tumour resection. Four cases (10%), all after laparotomy, had recurred after a median follow-up of 31 months (2-120), and 2 patients of the laparotomy group died due to their cancer. After a univariate analysis, the prognostic factors for a laparoscopic recurrence were: tumour size (P=.0001), mitosis number (P=.001), being a locally advanced tumour (P=.01) and a ruptured tumour (P=.002). Only size remained as a prognostic factor after the multivariate analysis (P=.029; RR 1.363; 95% CI; 1.033-1.799). The presence of a locally advanced tumour was shown to be significant in the univariate analysis, while there were no significant factors after the multivariate analysis (AU)

[Cervical anastomotic leak after esophagectomy: diagnosis and management]. / Fístula cervical postesofagectomía: diagnóstico y tratamiento.

INTRODUCTION: Cervical anastomotic leaks after esophagectomy are still a frequent and severe complication that needs an early diagnosis and an appropriate treatment. The aim of this study was to describe our experience with the management of this complication. PATIENTS AND METHODS: Retrospective study (2003-2011) of a consecutive series of 77 patients with a cervical esophagogastric anastomosis, 18 of them (23.3%) presenting a leak. Fistulae were classified into 4 groups depending on clinical presentation, radiology (esophagogram or CT), surgical findings (in case of re-operation) and, since 2010, endoscopic examination. Type I leaks were an asymptomatic or radiographic leak, type II had local signs limited to the neck, type III was associated with respiratory symptoms due to a pleural or mediastinal collection, and type IV with a systemic disorder secondary to gastric necrosis. RESULTS: Four patients (22.2%) were classified as type I, 8 (44.4%) as type II, 3 (16.6%) as type III, and 3 (16.6%) as type IV. Eight patients were managed conservatively; in 9 a self-expanding stent was used, 5 required a thoracotomy, and one of them (type IV) died. Leaks were related to a higher associated morbidity (61 versus 30%; P=.019) and a longer hospital stay (median of 28.5 vs 14 days; P=.009). CONCLUSIONS: Almost one quarter of cervical esophagogastric anastomoses present some kind of anastomotic leak. Although most of them can be treated conservatively or by endoscopy, they are associated with an increase in morbidity and mortality.