University of Oulu

Helminen, O., Kytö, V., Kauppila, J.H., Gunn, J., Lagergren, J. and Sihvo, E. (2019), Population‐based study of anastomotic stricture rates after minimally invasive and open oesophagectomy for cancer. BJS Open, 3: 634-640. doi:10.1002/bjs5.50176

Population-based study of anastomotic stricture rates after minimally invasive and open oesophagectomy for cancer

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Author: Helminen, O.1,2,3; Kytö, V.4,5; Kauppila, J. H.2,3,6;
Organizations: 1Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
2Cancer and Translational Medicine Research Unit, Medical Research Centre Oulu, University of Oulu, Oulu, Finland
3Department of Surgery, Oulu University Hospital, Oulu, Finland
4Heart Centre, Turku University Hospital, Turku, Finland
5Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
6Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
7Department of Surgery, Faculty of Medicine, University of Turku, Turku, Finland
8School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
9Guy's and St Thomas' NHS Foundation Trust, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: John Wiley & Sons, 2019
Publish Date: 2020-02-26


Background: The population‐based incidence of anastomotic stricture after minimally invasive oesophagectomy (MIO) and open oesophagectomy (OO) is not known. The aim of this study was to compare rates of anastomotic stricture requiring dilatation after the two approaches in an unselected cohort using nationwide data from Finland and Sweden.

Methods: All patients who had MIO or OO for oesophageal cancer between 2007 and 2014 were identified from nationwide registries in Finland and Sweden. Outcomes were the overall rate of anastomotic stricture and need for single or repeated (3 or more) dilatations for stricture within the first year after surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95 per cent confidence intervals, adjusted for age, sex, co‐morbidity, histology, stage, year, country, hospital volume, length of hospital stay and readmissions.

Results: Some 239 patients underwent MIO and 1430 had an open procedure. The incidence of strictures requiring one dilatation was 16·7 per cent, and that for strictures requiring three or more dilatations was 6·6 per cent. The HR for strictures requiring one dilatation was not increased after MIO compared with that after OO (HR 1·19, 95 per cent c.i. 0·66 to 2·12), but was threefold higher for repeated dilatations (HR 3·25, 1·43 to 7·36). Of 18 strictures following MIO, 14 (78 per cent) occurred during the first 2 years after initiating this approach.

Conclusion: The need for endoscopic anastomotic dilatation after oesophagectomy was common, and the need for repeated dilatation was higher after MIO than following OO. The increased risk after MIO may reflect a learning curve.

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Series: BJS open
ISSN: 2474-9842
ISSN-E: 2474-9842
ISSN-L: 2474-9842
Volume: 3
Issue: 5
Pages: 634 - 640
DOI: 10.1002/bjs5.50176
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study was supported by Finnish State Research Funding (O.H.), Instrumentarium Science Foundation (O.H.), Finnish Cardiac Society (V.K.), Finnish Cultural Foundation (V.K.), Sigrid Juselius Foundation (J.H.K.), Orion Research Foundation (J.H.K.), Swedish Research Council (J.L.) and the Swedish Cancer Society (J.L.).
Copyright information: © 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.