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1. Lasting Symptoms After Esophageal Resection (LASER): European Multicenter Cross-sectional Study.

Author

Markar SR, Zaninotto G, Castoro C, Johar A, Lagergren P, Elliott JA, Gisbertz SS, Mariette C, Alfieri R, Huddy J, Sounderajah V, Pinto E, Scarpa M, Klevebro F, Sunde B, Murphy CF, Greene C, Ravi N, Piessen G, Brenkman H, Ruurda JP, Van Hillegersberg R, Lagarde S, Wijnhoven B, Pera M, Roig J, Castro S, Matthijsen R, Findlay J, Antonowicz S, Maynard N, McCormack O, Ariyarathenam A, Sanders G, Cheong E, Jaunoo S, Allum W, Van Lanschot J, Nilsson M, Reynolds JV, van Berge Henegouwen MI, and Hanna GB

Subjects
Aged, Cross-Sectional Studies, Europe, Female, Humans, Male, Middle Aged, Self Report, Symptom Assessment, Esophageal Neoplasms surgery, Esophagectomy, Postoperative Complications epidemiology, Quality of Life
Abstract

Objective: To identify the most prevalent symptoms and those with greatest impact upon health-related quality of life (HRQOL) among esophageal cancer survivors., Background: Long-term symptom burden after esophagectomy, and associations with HRQOL, are poorly understood., Patients and Methods: Between 2010 and 2016, patients from 20 European Centers who underwent esophageal cancer surgery, and were disease-free at least 1 year postoperatively were asked to complete LASER, EORTC-QLQ-C30, and QLQ-OG25 questionnaires. Specific symptom questionnaire items that were associated with poor HRQOL as identified by EORTC QLQ-C30 and QLQ-OG25 were identified by multivariable regression analysis and combined to form a tool., Results: A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had symptoms associated with their esophagectomy. Ongoing weight loss was reported by 10.4% of patients, and only 13.8% returned to work with the same activities.Three LASER symptoms were correlated with poor HRQOL on multivariable analysis; pain on scars on chest (odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81 ± 0.02 and 0.82 ± 0.09 respectively., Conclusion: Two-thirds of patients experience significant symptoms more than 1 year after surgery. The 3 key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased support., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2022
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2. Patient-reported outcomes after oesophagectomy in the multicentre LASER study.

Author

Markar SR, Sounderajah V, Johar A, Zaninotto G, Castoro C, Lagergren P, Elliott JA, Gisbertz SS, Mariette C, Alfieri R, Huddy J, Pinto E, Scarpa M, Klevebro F, Sunde B, Murphy CF, Greene C, Ravi N, Piessen G, Brenkman H, Ruurda J, van Hillegersberg R, Lagarde SM, Wijnhoven BP, Pera M, Roigg J, Castro S, Matthijsen R, Findlay J, Antonowicz S, Maynard N, McCormack O, Ariyarathenam A, Sanders G, Cheong E, Jaunoo S, Allum W, van Lanschot J, Nilsson M, Reynolds JV, van Berge Henegouwen MI, and Hanna GB

Subjects
Aged, Cross-Sectional Studies, Europe epidemiology, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Quality of Life, Retrospective Studies, Time Factors, Treatment Outcome, Esophageal Neoplasms surgery, Esophagectomy methods, Patient Reported Outcome Measures, Postoperative Complications epidemiology
Abstract

Background: Data on the long-term symptom burden in patients surviving oesophageal cancer surgery are scarce. The aim of this study was to identify the most prevalent symptoms and their interactions with health-related quality of life., Methods: This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery in 20 European centres between 2010 and 2016. Patients had to be disease-free for at least 1 year. They were asked to complete a 28-symptom questionnaire at a single time point, at least 1 year after surgery. Principal component analysis was used to assess for clustering and association of symptoms. Risk factors associated with the development of severe symptoms were identified by multivariable logistic regression models., Results: Of 1081 invited patients, 876 (81.0 per cent) responded. Symptoms in the preceding 6 months associated with previous surgery were experienced by 586 patients (66.9 per cent). The most common severe symptoms included reduced energy or activity tolerance (30.7 per cent), feeling of early fullness after eating (30.0 per cent), tiredness (28.7 per cent), and heartburn/acid or bile regurgitation (19.6 per cent). Clustering analysis showed that symptoms clustered into six domains: lethargy, musculoskeletal pain, dumping, lower gastrointestinal symptoms, regurgitation/reflux, and swallowing/conduit problems; the latter two were the most closely associated. Surgical approach, neoadjuvant therapy, patient age, and sex were factors associated with severe symptoms., Conclusion: A long-term symptom burden is common after oesophageal cancer surgery., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)

Published
2021
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3. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

Author

S.K. Kamarajah, R.P.T. Evans, D. Nepogodiev, J. Hodson, J.R. Bundred, I. Gockel, J.A. Gossage, A. Isik, B. Kidane, H.A. Mahendran, I. Negoi, K.E. Okonta, R. Sayyed, R. van Hillegersberg, R.S. Vohra, B.P.L. Wijnhoven, P. Singh, E.A. Griffiths, D. Alderson, J. Bundred, J. Gossage, B. Jefferies, S. McKay, I. Mohamed, K. Siaw-Acheampong, R. Vohra, K. Wanigasooriya, T. Whitehouse, A. Gjata, J.I. Moreno, F.R. Takeda, R. Guevara Castro, T. Harustiak, A. Bekele, A. Kechagias, A. Kennedy, A. Da Roit, A. Bagajevas, J.S. Azagra, L. Mejía-Fernández, J. El Kafsi, R.H. Sayyed, M. Sousa, A.S. Sampaio, R. Blanco, B. Wallner, P.M. Schneider, P.K. Hsu, S. Gananadha, V. Wills, M. Devadas, C. Duong, M. Talbot, M.W. Hii, R. Jacobs, N.A. Andreollo, B. Johnston, G. Darling, A. Isaza-Restrepo, G. Rosero, F. Arias-Amézquita, D. Raptis, J. Gaedcke, D. Reim, J. Izbicki, J.H. Egberts, S. Dikinis, D.W. Kjaer, M.H. Larsen, M.P. Achiam, J. Saarnio, D. Theodorou, T. Liakakos, D.P. Korkolis, W.B. Robb, C. Collins, T. Murphy, J. Reynolds, V. Tonini, M. Migliore, L. Bonavina, M. Valmasoni, R. Bardini, J. Weindelmayer, M. Terashima, R.E. White, E. Alghunaim, M. Elhadi, A.M. Leon-Takahashi, H. Medina-Franco, P.C. Lau, J. Heisterkamp, C. Rosman, G. Beban, R. Babor, A. Gordon, J.I. Rossaak, K.M.I. Pal, A.U. Qureshi, S.A. Naqi, A.A. Syed, J. Barbosa, C.S. Vicente, J. Leite, J. Freire, R. Casaca, R.C.T. Costa, R.R. Scurtu, S.S. Mogoanta, C. Bolca, S. Constantinoiu, D. Sekhniaidze, M. Bjelović, J.B.Y. So, G. Gačevski, C. Loureiro, M. Pera, A. Bianchi, M. Moreno Gijón, J. Martín Fernández, M.S. Trugeda Carrera, M. Vallve-Bernal, M.A. Cítores Pascual, S. Elmahi, I. Halldestam, J. Hedberg, S. Mönig, S. Gutknecht, M. Tez, A. Guner, M.B. Tirnaksiz, E. Colak, B. Sevinç, A. Hindmarsh, I. Khan, D. Khoo, R. Byrom, J. Gokhale, P. Wilkerson, P. Jain, D. Chan, K. Robertson, S. Iftikhar, R. Skipworth, M. Forshaw, S. Higgs, R. Nijjar, Y.K.S. Viswanath, P. Turner, S. Dexter, A. Boddy, W.H. Allum, S. Oglesby, E. Cheong, D. Beardsmore, N. Maynard, R. Berrisford, S. Mercer, S. Puig, R. Melhado, C. Kelty, T. Underwood, K. Dawas, W. Lewis, A. Al-Bahrani, G. Bryce, M. Thomas, A.T. Arndt, F. Palazzo, R.A. Meguid, J. Fergusson, E. Beenen, C. Mosse, J. Salim, S. Cheah, T. Wright, M.P. Cerdeira, P. McQuillan, M. Richardson, H. Liem, J. Spillane, M. Yacob, F. Albadawi, T. Thorpe, A. Dingle, C. Cabalag, K. Loi, O.M. Fisher, S. Ward, M. Read, M. Johnson, R. Bassari, H. Bui, I. Cecconello, R.A.A. Sallum, J.R.M. da Rocha, L.R. Lopes, V. Tercioti, J.D.S. Coelho, J.A.P. Ferrer, G. Buduhan, L. Tan, S. Srinathan, P. Shea, J. Yeung, F. Allison, P. Carroll, F. Vargas-Barato, F. Gonzalez, J. Ortega, L. Nino-Torres, T.C. Beltrán-García, L. Castilla, M. Pineda, A. Bastidas, J. Gómez-Mayorga, N. Cortés, C. Cetares, S. Caceres, S. Duarte, A. Pazdro, M. Snajdauf, H. Faltova, M. Sevcikova, P.B. Mortensen, N. Katballe, T. Ingemann, B. Morten, I. Kruhlikava, A.P. Ainswort, N.M. Stilling, J. Eckardt, J. Holm, M. Thorsteinsson, M. Siemsen, B. Brandt, B. Nega, E. Teferra, A. Tizazu, J.H. Kauppila, V. Koivukangas, S. Meriläinen, R. Gruetzmann, C. Krautz, G. Weber, H. Golcher, G. Emons, A. Azizian, M. Ebeling, S. Niebisch, N. Kreuser, G. Albanese, J. Hesse, L. Volovnik, U. Boecher, M. Reeh, S. Triantafyllou, D. Schizas, A. Michalinos, E. Balli, M. Mpoura, A. Charalabopoulos, D.K. Manatakis, D. Balalis, J. Bolger, C. Baban, A. Mastrosimone, O. McAnena, A. Quinn, C.B. Ó Súilleabháin, M.M. Hennessy, I. Ivanovski, H. Khizer, N. Ravi, N. Donlon, M. Cervellera, S. Vaccari, S. Bianchini, l. Sartarelli, E. Asti, D. Bernardi, S. Merigliano, L. Provenzano, M. Scarpa, L. Saadeh, B. Salmaso, G. De Manzoni, S. Giacopuzzi, R. La Mendola, C.A. De Pasqual, Y. Tsubosa, M. Niihara, T. Irino, R. Makuuchi, K. Ishii, M. Mwachiro, A. Fekadu, A. Odera, E. Mwachiro, D. AlShehab, H.A. Ahmed, A.O. Shebani, A. Elhadi, F.A. Elnagar, H.F. Elnagar, S.T. Makkai-Popa, L.F. Wong, Y.R. Tan, S. Thannimalai, C.A. Ho, W.S. Pang, J.H. Tan, H.N.L. Basave, R. Cortés-González, S.M. Lagarde, J.J.B. van Lanschot, C. Cords, W.A. Jansen, I. Martijnse, R. Matthijsen, S. Bouwense, B. Klarenbeek, M. Verstegen, F. van Workum, J.P. Ruurda, P.C. van der Sluis, M. de Maat, N. Evenett, P. Johnston, R. Patel, A. MacCormick, M. Young, B. Smith, C. Ekwunife, A.H. Memon, K. Shaikh, A. Wajid, N. Khalil, M. Haris, Z.U. Mirza, S.B.A. Qudus, M.Z. Sarwar, A. Shehzadi, A. Raza, M.H. Jhanzaib, J. Farmanali, Z. Zakir, O. Shakeel, I. Nasir, S. Khattak, M. Baig, Noor MA, H.H. Ahmed, A. Naeem, A.C. Pinho, R. da Silva, A. Bernardes, J.C. Campos, H. Matos, T. Braga, C. Monteiro, P. Ramos, F. Cabral, M.P. Gomes, P.C. Martins, A.M. Correia, J.F. Videira, C. Ciuce, R. Drasovean, R. Apostu, S. Paitici, A.E. Racu, C.V. Obleaga, M. Beuran, B. Stoica, C. Ciubotaru, V. Negoita, I. Cordos, R.D. Birla, D. Predescu, P.A. Hoara, R. Tomsa, V. Shneider, M. Agasiev, I. Ganjara, D. Gunjić, M. Veselinović, T. Babič, T.S. Chin, A. Shabbir, G. Kim, A. Crnjac, H. Samo, I. Díez del Val, S. Leturio, J.M. Ramón, M. Dal Cero, S. Rifá, M. Rico, A. Pagan Pomar, J.A. Martinez Corcoles, J.L. Rodicio Miravalles, S.A. Pais, S.A. Turienzo, L.S. Alvarez, P.V. Campos, A.G. Rendo, S.S. García, E.P.G. Santos, E.T. Martínez, M.J. Fernández Díaz, C. Magadán Álvarez, V. Concepción Martín, C. Díaz López, A. Rosat Rodrigo, L.E. Pérez Sánchez, M. Bailón Cuadrado, C. Tinoco Carrasco, E. Choolani Bhojwani, D.P. Sánchez, M.E. Ahmed, T. Dzhendov, F. Lindberg, M. Rutegård, M. Sundbom, C. Mickael, N. Colucci, A. Schnider, S. Er, E. Kurnaz, S. Turkyilmaz, A. Turkyilmaz, R. Yildirim, B.E. Baki, N. Akkapulu, O. Karahan, N. Damburaci, R. Hardwick, P. Safranek, V. Sujendran, J. Bennett, Z. Afzal, M. Shrotri, B. Chan, K. Exarchou, T. Gilbert, T. Amalesh, D. Mukherjee, S. Mukherjee, T.H. Wiggins, R. Kennedy, S. McCain, A. Harris, G. Dobson, N. Davies, I. Wilson, D. Mayo, D. Bennett, R. Young, P. Manby, N. Blencowe, M. Schiller, B. Byrne, D. Mitton, V. Wong, A. Elshaer, M. Cowen, V. Menon, L.C. Tan, E. McLaughlin, R. Koshy, C. Sharp, H. Brewer, N. Das, M. Cox, W. Al Khyatt, D. Worku, R. Iqbal, L. Walls, R. McGregor, G. Fullarton, A. Macdonald, C. MacKay, C. Craig, S. Dwerryhouse, S. Hornby, S. Jaunoo, M. Wadley, C. Baker, M. Saad, M. Kelly, A. Davies, F. Di Maggio, P. Mistry, R. Singhal, O. Tucker, S. Kapoulas, S. Powell-Brett, P. Davis, G. Bromley, L. Watson, R. Verma, J. Ward, V. Shetty, C. Ball, K. Pursnani, A. Sarela, H. Sue Ling, S. Mehta, J. Hayden, N. To, T. Palser, D. Hunter, K. Supramaniam, Z. Butt, A. Ahmed, S. Kumar, A. Chaudry, O. Moussa, A. Kordzadeh, B. Lorenzi, M. Wilson, P. Patil, I. Noaman, J. Willem, G. Bouras, R. Evans, M. Singh, H. Warrilow, A. Ahmad, N. Tewari, F. Yanni, J. Couch, E. Theophilidou, J.J. Reilly, null van Boxel Gijs, K. Akbari, D. Zanotti, B. Sgromo, G. Sanders, T. Wheatley, A. Ariyarathenam, A. Reece-Smith, L. Humphreys, C. Choh, N. Carter, B. Knight, P. Pucher, A. Athanasiou, B. Tan, M. Abdulrahman, J. Vickers, K. Akhtar, R. Chaparala, R. Brown, M.M.A. Alasmar, R. Ackroyd, K. Patel, A. Tamhankar, A. Wyman, R. Walker, B. Grace, N. Abbassi, N. Slim, L. Ioannidi, G. Blackshaw, T. Havard, X. Escofet, A. Powell, A. Owera, F. Rashid, P. Jambulingam, J. Padickakudi, H. Ben-Younes, K. Mccormack, I.A. Makey, M.K. Karush, C.W. Seder, M.J. Liptay, G. Chmielewski, E.L. Rosato, A.C. Berger, R. Zheng, E. Okolo, A. Singh, C.D. Scott, M.J. Weyant, J.D. Mitchell, Surgery, Intensive Care, Radiotherapy, Oral and Maxillofacial Surgery, Rheumatology, Medical Microbiology & Infectious Diseases, Erasmus MC other, Hematology, Gastroenterology & Hepatology, Public Health, Medical Informatics, Internal Medicine, Public Administration, Epidemiology, Erasmus School of Economics, Cell biology, Pathology, Health Services Management & Organisation (HSMO), and Molecular Genetics

Subjects
Pulmonary and Respiratory Medicine, Esophageal Neoplasms, Anastomosis, Anastomotic Leak, outcomes, Esophageal Neoplasms/surgery, surgical techniques, Cohort Studies, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], Necrosis, Postoperative Complications, Esophagectomy/adverse effects, SDG 3 - Good Health and Well-being, Surgical, Surgical Stapling, anastomotic leak, esophageal cancer, esophagectomy, Anastomosis, Surgical, Esophagectomy, Humans, Suture Techniques, Anastomosis, Surgical/adverse effects, Suture Techniques/adverse effects, Surgical Stapling/adverse effects, Surgery, Postoperative Complications/etiology, Necrosis/surgery, Cardiology and Cardiovascular Medicine, Anastomotic Leak/etiology
Abstract

BACKGROUND: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.METHODS: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.RESULTS: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.CONCLUSIONS: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Published
2022
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4. The management of chyle leak post-oesophagectomy for oesophageal carcinoma: a systematic review

Author

A V Robinson, T Roper, M Khan, L Kennedy, and S Jaunoo

Subjects
medicine.medical_specialty, Leak, Chyle, Esophageal Neoplasms, business.industry, General surgery, Incidence (epidemiology), MEDLINE, Chylothorax, General Medicine, Review, medicine.disease, Thoracic duct, Esophagectomy, medicine.anatomical_structure, Radiological weapon, medicine, Humans, Surgery, Prospective Studies, Complication, business
Abstract

Introduction Chyle leak is an uncommon yet potentially fatal complication of oesophagectomy for oesophageal cancer. The management of chyle leak is a debated, controversial topic and to date there is no standardised approach or validated algorithm for its management. This review aims to summarise current treatment algorithms for chyle leak post-oesophagectomy and their outcomes. Methods A systematic search of Embase, MEDLINE, UpToDate and Cochrane was conducted to identify studies reporting on the management of chyle leak following oesophagectomy for oesophageal cancer. Data on interventional success rate and mortality are reported. Findings Twenty-one studies met the inclusion criteria including over 23,254 oesophagectomies and identifying 838 chyle leaks (incidence Conclusions Owing to the heterogeneity of treatment algorithms, timings and indications for interventions, the optimal strategy for managing chyle leak remains unclear. This review has identified an unmet need for prospective multicentre studies assessing the efficacy of predefined algorithms.

Published
2021

5. Feeding jejunostomy in upper gastrointestinal resections: a UK-wide survey

Author

P Ireland and S Jaunoo

Subjects
medicine.medical_specialty, medicine.medical_treatment, Jejunostomy, Upper GI Surgery, Upper gastrointestinal cancer, 03 medical and health sciences, 0302 clinical medicine, Enteral Nutrition, Gastrectomy, Surveys and Questionnaires, Upper gastrointestinal, Medicine, Humans, In patient, Practice Patterns, Physicians', Digestive System Surgical Procedures, business.industry, General surgery, General Medicine, United Kingdom, Esophagectomy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, Parenteral Nutrition, Total, business, Feeding jejunostomy
Abstract

Introduction The usage of a feeding jejunostomy has been a well-established practice in maintaining nutrition in patients undergoing resections for upper gastrointestinal cancer. As surgical technique has evolved, together with the adoption of enhanced recovery after surgery pathways, the routine insertion of feeding jejunostomy tubes appears to be changing. Materials and methods A survey was constructed using Google Forms. The link was distributed to consultant upper gastrointestinal surgeons via the Association of Upper Gastrointestinal Surgeons’ membership database. Results were collated and analysed using Microsoft Excel. Results A total of 55 responses were received from 28 units across the UK; 27 respondents (49.1%) no longer routinely use feeding jejunostomy in upper gastrointestinal resections, oesophagectomy or gastrectomy. The most common primary feeding modality used by these respondents was oral diet 17 (65.4%), with total parenteral nutrition (19.2%) and nasojejunal (11.5%) routes also being used. Respondents who used feeding jejunostomies inserted them primarily for oesophagectomy (n = 27; 96.4%), with fewer surgeons using them in extended total gastrectomy (n = 12; 42.9%) and total gastrectomy (n = 11; 39.3%). Of the total, 20 surgeons (71.4%) would insert the jejunostomy using an open approach, with 19 (67.9%) employing a Witzel tunnel. Eleven respondents (39.3%) would continue feeding via the jejunostomy after discharge. Some 24 responders thought that feeding jejunostomies did not facilitate the enhanced recovery after surgery pathway (strongly and slightly disagree), whereas 17 considered that they did (strongly and slightly agree); 13 responders did not have strong views either way. Conclusions There is a split in current practice regarding the usage of feeding jejunostomies. There is also a division of opinion on the role of feeding jejunostomy in enhanced recovery after surgery.

Published
2020

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