Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author BARCHI, Leandro Cardoso FMUSP-HC
RAMOS, Marcus Fernando Kodama Pertille FMUSP-HC
PEREIRA, Marina Alessandra FMUSP-HC
DIAS, Andre Roncon FMUSP-HC
RIBEIRO-JUNIOR, Ulysses FMUSP-HC
ZILBERSTEIN, Bruno FMUSP-HC
CECCONELLO, Ivan FMUSP-HC
dc.date.issued 2019
dc.identifier.citation UPDATES IN SURGERY, v.71, n.3, p.429-438, 2019
dc.identifier.issn 2038-131X
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/33485
dc.description.abstract Gastric cancer surgery has evolved considerably over the past years, with substantial improvement on outcomes. Meanwhile, esophagojejunal anastomotic fistula (EJF) continues to impair postoperative results. This study aimed to assess EJF regarding its incidence, risk factors, management and the impact on overall survival. We retrospectively analyzed 258 consecutive patients who underwent total or completion gastrectomy for GC from 2009 and 2017. Clinicopathological characteristics analysis was performed comparing patients who developed EJF with patients with other clinical or surgical complications, as well as patients without any postoperative complications. Fifteen (5.8%) patients had EJF and 81 (31.4%) had other complications (including other surgical fistulas). The median time of EJF diagnosis was on the eighth postoperative day (range 3-76). Completion gastrectomy (p = 0.048) and longer hospital stay (p < 0.001) were associated with the occurrence of EJF. The surgical mortality of patients with EJF was higher than in non-EJF patients (26.7% vs. 4.5%; p < 0.001). Nine patients were treated conservatively and six required surgery. The mortality rate of EJF was 11.1% and 50% in patients who underwent conservative and surgical treatment, respectively. Patients with other complications and patients with EJF had worse survival compared to patients without any complication (p = 0.004 and p = 0.013, respectively). Completion gastrectomy is the main risk factor for EJF occurrence. Still, EJF is associated with high postoperative mortality, longer hospital stay and has a negative impact on long-term survival.
dc.language.iso eng
dc.publisher SPRINGER-VERLAG ITALIA SRL
dc.relation.ispartof Updates in Surgery
dc.rights restrictedAccess
dc.subject Stomach neoplasms; Gastrectomy; Postoperative complications; Digestive system fistula
dc.subject.other long-term survival; gastric-cancer; postoperative complications; leakage; risk; esophageal; resection; surgery; impact; classification
dc.title Esophagojejunal anastomotic fistula: a major issue after radical total gastrectomy
dc.type article
dc.rights.holder Copyright SPRINGER-VERLAG ITALIA SRL
dc.description.group LIM/24
dc.description.group LIM/35
dc.identifier.doi 10.1007/s13304-019-00659-8
dc.identifier.pmid 31161587
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author BARCHI, Leandro Cardoso:FM:
hcfmusp.author RAMOS, Marcus Fernando Kodama Pertille:HC:ICESP
hcfmusp.author PEREIRA, Marina Alessandra:HC:ICESP
hcfmusp.author DIAS, Andre Roncon:HC:ICESP
hcfmusp.author RIBEIRO-JUNIOR, Ulysses:FM:MGT
hcfmusp.author ZILBERSTEIN, Bruno:FM:MGT
hcfmusp.author CECCONELLO, Ivan:FM:MGT
hcfmusp.origem.id WOS:000479252600004
hcfmusp.origem.id 2-s2.0-85067054536
hcfmusp.publisher.city MILAN
hcfmusp.publisher.country ITALY
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dc.description.index MEDLINE
dc.identifier.eissn 2038-3312
hcfmusp.citation.scopus 1
hcfmusp.citation.wos 1


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