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  1. Article ; Online: Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center.

    Talavera-Urquijo, Eider / Parise, Paolo / Carresi, Agnese / Cossu, Andrea / Barbieri, Lavinia / Puccetti, Francesco / Elmore, Ugo / Rosati, Riccardo

    Updates in surgery

    2022  Volume 75, Issue 2, Page(s) 435–449

    Abstract: A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF ... ...

    Abstract A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
    MeSH term(s) Humans ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Retrospective Studies ; Tertiary Care Centers ; Esophageal Neoplasms/surgery ; Esophageal Fistula/etiology ; Esophageal Fistula/surgery ; Anastomosis, Surgical/adverse effects
    Language English
    Publishing date 2022-08-22
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-022-01364-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 101: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  2. Article: Diaphragmatic hernia after Ivor Lewis esophagectomy for cancer: a retrospective analysis of risk factors and post-repair outcomes.

    Puccetti, Francesco / Cossu, Andrea / Parise, Paolo / Barbieri, Lavinia / Elmore, Ugo / Carresi, Agnese / De Pascale, Stefano / Fumagalli Romario, Uberto / Rosati, Riccardo

    Journal of thoracic disease

    2021  Volume 13, Issue 1, Page(s) 160–168

    Abstract: Background: Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with ... ...

    Abstract Background: Esophageal cancer surgery has historically been associated with high levels of postoperative morbidity and mortality. Post-esophagectomy diaphragmatic hernia (PEDH) represents a potentially life-threatening surgical complication, with incidence and risk factors not clearly demonstrated. This study evaluates presenting characteristics and repair outcomes in PEDH after Ivor Lewis esophagectomy for cancer.
    Methods: All consecutive patients who underwent esophageal cancer surgery between March 1997 and April 2018 at two high-volume centers were included. The patients underwent Ivor Lewis esophagectomy and were managed according to a standardized follow-up care plan. The primary outcomes included PEDH incidence, risk factor identification, and surgical results after hernia repair. Patient characteristics and perioperative data were collected and a multivariate analysis was performed to identify risk factors for PEDH.
    Results: A total of 414 patients were enrolled and 22 (5.3%) were diagnosed with PEDH during a median follow-up period of 16 (range, 6-177) months. All patients underwent surgical repair and 16 (73%) required treatment within 24 hours. PEDH repair was mainly performed through a laparoscopic approach (77.3%), with an overall postoperative morbidity of 22.7% and one mortality case. The median length of hospital stay was 6 (range, 2-95) days, and no early recurrences were observed, although three (13.6%) cases relapsed over a median follow-up of 10.1 months after hernia repair. Univariate analysis demonstrated a statistically significant association between PEDH and neoadjuvant chemoradiotherapy (P=0.016), pathological complete response (P=0.001), and lymph node harvest (P=0.024). On the other hand, multivariate analysis identified pathological complete response [3.616 (1.384-9.449), P=0.009] and lymph node harvest [3.029 (1.140-8.049), P=0.026] as the independent risk factors for developing PEDH.
    Conclusions: PEDH represents a relevant surgical complication after Ivor Lewis esophagectomy for cancer, including a 5.3% incidence and requiring surgical repair. Pathological complete response and lymph node harvest were found to be independent risk factors for PEDH, independently of the esophagectomy technique.
    Language English
    Publishing date 2021-01-25
    Publishing country China
    Document type Journal Article
    ZDB-ID 2573571-8
    ISSN 2077-6624 ; 2072-1439
    ISSN (online) 2077-6624
    ISSN 2072-1439
    DOI 10.21037/jtd-20-1974
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Application of ERAS protocol in esophagectomy: a national survey among Italian centers performing esophageal surgery.

    Parise, Paolo / Turi, Stefano / Talavera-Urquijo, Eider / Carresi, Agnese / Barbieri, Lavinia / Cossu, Andrea / Elmore, Ugo / Puccetti, Francesco / Rosati, Riccardo

    Updates in surgery

    2021  Volume 73, Issue 1, Page(s) 297–303

    Abstract: The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions ... ...

    Abstract The application of enhanced recovery after surgery guidelines for esophageal surgery in different units remains unclear. This survey intended to investigate how such protocol is applied among Italian esophageal surgery units. A survey with 40 questions was mailed to Italian centers that performed at least 10 esophagectomies per year. It included questions about the type of hospital and unit and pre-, intra- and post-operative items. Difficulties encountered were investigated. Thirteen (65%) centers answered the survey, and all met the minimal safety requirements, e.g., the presence of intensive care units and 24-h on-call operative endoscopy and radiology facilities. Fifty percent of esophagectomies with a minimally invasive approach were performed in 84.6% of the centers. Regarding pre-operative items, the highest scores were for the application of nutritional support, dysphagia palliation and presence of a multidisciplinary tumor board, whereas the lowest score was for the use of immunonutrition. Regarding intra-operative items, hypothermia prevention and the use of goal-directed fluid therapy and volatile anesthesia were diffusely adopted, whereas the rate of using abdominal drains was high. Regarding post-operative items, nausea prevention, multimodal analgesia and early mobilization were applied frequently, whereas the use of nasogastric tubes and regular transfer to intensive care units was diffused. The primary barriers in enhanced recovery after surgery protocol application were resistance and a lack of paramedic personnel. This survey's results highlight the efforts undertaken by several centers to apply enhanced recovery after surgery philosophy and in this regard, demonstrate a good standing in Italy.
    MeSH term(s) Enhanced Recovery After Surgery ; Esophagectomy/methods ; Esophagectomy/statistics & numerical data ; Esophagus/surgery ; Humans ; Italy/epidemiology ; Minimally Invasive Surgical Procedures/methods ; Minimally Invasive Surgical Procedures/statistics & numerical data ; Perioperative Care ; Surgery Department, Hospital/statistics & numerical data ; Surveys and Questionnaires
    Language English
    Publishing date 2021-01-13
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-020-00963-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

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    Kategorien

    In stock of ZB MED Cologne/Königswinter

    Zs.B 101: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

    Order via subito

    This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

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