Dislocation of the Cervical Anastomosis toward the Mediastinum after McKeown Esophagectomy: A Single-Center Retrospective Study

Abstract

Background: This study aimed to assess the frequency of cervical anastomosis dislocation toward the mediastinum after McKeown esophagectomy and the significance of this phenomenon for postoperative complications. Methods and Results: The study included 82 patients with stage I-III esophageal cancer who underwent surgical intervention using McKeown esophagectomy in a completely open version (thoracotomy, laparotomy, cervicotomy) or hybrid esophagectomy (thoracoscopy on the right, laparotomy, cervicotomy). After McKeown esophagectomy, dislocation of the cervical anastomosis (DCA) toward the posterior mediastinum was noted in 26.8% of cases. The overall incidence of anastomotic leakage was 18.3%. The groups of patients with and without DCA did not differ statistically in the incidence of anastomotic leakage (P=0.205). Mediastinal complications (mediastinitis, pleural empyema) were observed in 100% (6/6) of cases in the group with DCA and 33.3% (3/9) of cases in the group without DCA (P=0.013). Pulmonary complications (pneumonia, atelectasis) occurred in 5(22.7%) and 8(13.3%) of cases in groups with DCA and without DCA, respectively (P = 0.304). Conclusion: After McKeown esophagectomy, DCA toward the posterior mediastinum was noted in 26.8% of cases. Dislocation of the cervical anastomosis toward the posterior mediastinum does not significantly impact the anastomotic leakage. Mediastinal complications are more common in patients with DCA, but the incidence of pulmonary complications is not associated with this phenomenon.

Keywords

• esophageal cancer
• mckeown esophagectomy
• anastomosis dislocation