Association of conduit dimensions with perioperative outcomes and long-term quality of life after esophagectomy for malignancyCentral MessagePerspective
SangMin Kim, MD,
Sun Yeop Lee, MS,
Nuno Vaz, MD,
Rachel Leo, BA,
Rafael R. Barcelos, MD,
Rena Mototani, BA,
Antonio Lozano, BA,
Evert Andrew Sugarbaker, BS,
Sarah S. Oh, PhD,
Francine Jacobson, MD,
Jon O. Wee, MD,
Michael T. Jaklitsch, MD,
M. Blair Marshall, MD
Affiliations
SangMin Kim, MD
Harvard Medical School, Boston, Mass; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass; Address for reprints: SangMin Kim, MD, Program in Medical Education, Division of Thoracic Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
Sun Yeop Lee, MS
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
Nuno Vaz, MD
Department of Radiology, Brigham and Women's Hospital, Boston, Mass
Rachel Leo, BA
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
Rafael R. Barcelos, MD
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
Rena Mototani, BA
Tokyo Medical and Dental University, Tokyo, Japan
Antonio Lozano, BA
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
Evert Andrew Sugarbaker, BS
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
Sarah S. Oh, PhD
Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
Francine Jacobson, MD
Department of Radiology, Brigham and Women's Hospital, Boston, Mass
Jon O. Wee, MD
Harvard Medical School, Boston, Mass; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
Michael T. Jaklitsch, MD
Harvard Medical School, Boston, Mass; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
M. Blair Marshall, MD
Harvard Medical School, Boston, Mass; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
Objective: The impact of conduit dimensions and location of esophagogastric anastomosis on long-term quality of life after esophagectomy remains unexplored. We investigated the association of these parameters with surgical outcomes and patient-reported quality of life at least 18 months after esophagectomy. Methods: We identified all patients who underwent esophagectomy for cancer from 2018 to 2020 in our institution. We reviewed each patient's initial postoperative computed tomography scan measuring the gastric conduit's greatest width (centimeters), linear staple line length (centimeters), and relative location of esophagogastric anastomosis (vertebra). Quality of life was ascertained using patient-reported outcome measures. Perioperative complications, length of stay, and mortality were collected. Multivariate regressions were performed. Results: Our study revealed that a more proximal anastomosis was linked to an increased risk of pulmonary complications, a lower recurrence rate, and greater long-term insomnia. Increased maximum intrathoracic conduit width was significantly associated with trouble enjoying meals and reflux long term after esophagectomy. A longer conduit stapled line correlated with fewer issues related to insomnia, improved appetite, less dysphagia, and significantly enhanced “social,” “role,” and “physical'” aspects of the patient's long-term quality of life. Conclusions: The dimensions of the gastric conduit and the height of the anastomosis may be independently associated with outcomes and long-term quality of life after esophagectomy for cancer.
