ANASTOMOTIC STRICTURE AFTER ESOPHAGECTOMY AND GASTRIC TUBE RECONSTRUCTION FOR ESOPHAGEAL CANCER - RETROSPECTIVE ANALYSIS FROM 1989 TO 1995

Common late complications after esophagectomy and gastric tube reconst ruction for esophageal carcinoma are symptomatic, benign fibrotic sten oses of the cervical anastomosis, which require dilatation. Since the prognosis of esophageal carcinoma still remains poor, bad functional r esults such as dysphagia affect quality of life. In a retrospective an alysis, our patients were evaluated with regard to the underlying effe cts of cervical anastomotic stenosis after esophagectomy and gastric t ube reconstruction. From 1 January 1989 to 31 July 1995, 173 patients with carcinoma of the esophagus were operated in our institution. Tran shiatal esophageal dissection was performed in 133 patients; 40 patien ts underwent transthoracic en bloc resection. The 30-day mortality rat e was 7.5% (13 patients). Postoperative fibrotic stenosis of the cervi cal anastomosis requiring dilatation occurred in 36.4% (63 patients) 6 - 12 weeks after operation. Fibrotic stenosis of the cervical anastom osis did not develop in 97 patients. There was a significant differenc e concerning the incidence of anastomotic leaks within both groups: wh ereas in 23.8% of the 63 patients who developed a fibrotic stricture o f the cervical anastomosis an anastomotic leak preceded this event (P< 0.001), no anastomotic leak occurred in the group of 97 patients with normal healing of the cervical anastomosis. In addition, significantly (P<0.01) more patients (37.5%, n = 23) with preexisting diabetes mell itus could be found among the 63 patients who developed a fibrotic str icture of the cervical anastomosis, in contrast to the 97 patients wit hout anastomotic stenosis.