Intrathoracic anastomotic stenosis after resection in esophageal cancer

Background: In this study, we assessed the postoperative anastomotic stenosis in patients undergoing intrathoracic esophagogastric anastomosis with the stapler. Methods: Between January 2000 and December 2007, 132 patients who were operated due to esophageal cancer in Thoracic Surgery Clinic were retrospectively analyzed. The reconstruction was performed by the resection of 7-8 cm tumor free tissue proximally and distally. For all patients, the transthoracic esophagogastric anastomosis with end-to-end anastomosis (EEA) stapler was performed. Results: The in-hospital mortality rate was 5.3% (n=7), while 15 patients (12.0%) developed anastomotic stenosis. The incidences of the anastomotic stenosis in female and male patients were 11.7% (9/77) and 12.5% (6/48), respectively. The anastomotic stenosis was developed in nine (13.4%) and six (10.3%) patients in which the anastomosis were performed by using 25 mm and 28 mm stapler, respectively. The rate of the anastomotic stenosis were 25% (13/52) and 2.9% (2/69) in patients with the tumor located in 1/3 middle or 1/3 distal and cardia, respectively. The mean duration of the stenosis development was 3.9 months (range, 2-8 months). The mean dilatation cure was 1.7 sessions (range, 2-6 sessions). Symptoms of all patients were relieved by means of balloon dilatation and no complication related to the procedure was seen. Conclusion: Although the stapler contributes to the improvement of morbidity and mortality after the resection in esophageal cancer, it usually does not decrease the incidence of the anastomotic stenosis. We believe that surgical techniques should be improved and appropriate stapler devices should be developed to reduce the complications which may affect the patient comfort and psychology adversely.