Omission of intraoperative pyloric procedures in minimally invasive esophagectomy: assessing the impact on patients
Pyloroplasty or pyloromyotomy is often undertaken during esophagectomy to aid gastric emptying postoperatively. Minimally invasive esophagectomy (MIE) frequently omits a pyloric procedure. The impact on perioperative outcomes and the need for subsequent interventions is unclear. This study assesses the requirements for endoscopic balloon dilation of the pylorus (EPD) following MIE. Patients undergoing MIE from 2016 to 2020 were reviewed. Patients undergoing open resection, or an intraoperative pyloric procedure were excluded. Demographic, clinical and pathological data were reviewed. Univariable and multivariable analysis were performed as appropriate. In total, 171 patients underwent MIE. There were no differences in age (median 65 vs. 65 years, P = 0.6), pathological stage (P = 0.10) or ASA status (P = 0.52) between those requiring and not requiring endoscopic pyloric dilation (EPD). Forty-three patients (25%) required EPD, with a total of 71 procedures. Twenty-seven patients (16%) had EPD on their index admission. Seventy-five patients (43%) had a postoperative complication. Higher ASA status was associated with increased requirement for EPD (odds ratio 10.8, P = 0.03). On multivariable analysis, there was no association between the need for a pyloric procedure and overall survival (P = 0.14). Eight patients (5%) required insertion of a feeding jejunostomy in the postoperative period, with no difference between those with or without EPD (P = 0.11). Two patients required subsequent surgical pyloromyotomy for delayed gastric emptying. Although pyloroplasty or pyloromyotomy can safely be excluded during MIE, a quarter of patients will require postoperative EPD procedures. The impact of excluding pyloric procedures on gastric emptying requires further study.
Colles Grant from the Royal College of Surgeons in Ireland
CommentsThis is a pre-copyedited, author-produced PDF of an article accepted for publication in Diseases of the Esophagus following peer review. The version of record Bolger JC, Lau H, Yeung JC, Darling GE. Omission of intraoperative pyloric procedures in minimally invasive esophagectomy: assessing the impact on patients. Dis Esophagus. 2023;36(3):doac061.is available online at: https://doi.org/10.1093/dote/doac061
Published CitationBolger JC, Lau H, Yeung JC, Darling GE. Omission of intraoperative pyloric procedures in minimally invasive esophagectomy: assessing the impact on patients. Dis Esophagus. 2023;36(3):doac061.
Publication Date8 September 2022
PublisherOxford University Press
- Accepted Version (Postprint)