Subscribe to RSS
Long-Term Radiologic Evaluation of Microaspirations among Patients after Esophagectomy
Objectives Aspirations are common after esophagectomy. Data are lacking regarding its long-term radiological manifestations. The purpose of this study is to determine the incidence and radiological patterns of aspirations among long-term survivors and evaluate their clinical significance.
Methods The records of all patients who underwent esophagectomy between October 2003 and December 2011 and survived more than 3 years were reviewed. Preoperative, first routine postoperative, and latest chest computed tomography (CT)scans were reviewed. Imaging studies were reviewed for radiological signs suspicious of aspirations, conduit location, anastomotic site, and maximal intrathoracic diameter. Data regarding patients' complaints during clinic visits were also collected.
Results A total of 578 patients underwent esophagectomy during the study period. One-hundred twenty patients met the inclusion criteria. Median follow-up was 83.5 months. Cervical and intrathoracic anastomoses were performed in 103 and 17 patients, respectively. A higher rate of CT findings was found in postoperative imaging (n = 51 [42.5%] vs. n = 13 [10.8%] respectively, p < 0.05). Most of these were found in the lower lobes (61%). A higher rate of lesions was found among patients in whom the conduit was bulging to the right hemithorax compared with totally mediastinal or completely in the right hemithorax (54.5 vs. 35.2% and 34.6%, respectively, p < 0.05). No correlation was found with conduit diameter or anastomotic site. These lesions were more prevalent among patients who complained of reflux or cough during meals (NS).
Conclusions A significantly higher rate of new CT findings was found in postoperative imaging of this post-esophagectomy cohort, suggesting a high incidence of aspirations. The locations of the conduit, rather than anastomosis site, seem to play a role in the development of these findings. Further research is needed to evaluate the clinical significance of these findings.
Authors have no financial disclosures.
Authors have no conflict of interests.
All authors contributed significantly to the content of the article.
Received: 24 February 2020
Accepted: 24 March 2020
27 June 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Berry MF, Atkins BZ, Tong BC, Harpole DH, D'Amico TA, Onaitis MW. A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia. J Thorac Cardiovasc Surg 2010; 140 (06) 1266-1271
- 2 Leder SB, Bayar S, Sasaki CT, Salem RR. Fiberoptic endoscopic evaluation of swallowing in assessing aspiration after transhiatal esophagectomy. J Am Coll Surg 2007; 205 (04) 581-585
- 3 Atkins BZ, Shah AS, Hutcheson KA. et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78 (04) 1170-1176 , discussion 1170–1176
- 4 Pereira-Silva JL, Silva CI, Araújo Neto CA, Andrade TL, Müller NL. Chronic pulmonary microaspiration: high-resolution computed tomographic findings in 13 patients. J Thorac Imaging 2014; 29 (05) 298-303
- 5 Barnes TW, Vassallo R, Tazelaar HD, Hartman TE, Ryu JH. Diffuse bronchiolar disease due to chronic occult aspiration. Mayo Clin Proc 2006; 81 (02) 172-176
- 6 Marik PE. Pulmonary aspiration syndromes. Curr Opin Pulm Med 2011; 17 (03) 148-154
- 7 Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001; 344 (09) 665-671
- 8 Yamamoto S, Makuuchi H, Shimada H. et al. Clinical analysis of reflux esophagitis following esophagectomy with gastric tube reconstruction. J Gastroenterol 2007; 42 (05) 342-345
- 9 Park CH, Lee JI, Sung J, Choi S, Ko KP. A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition. J Cardiothorac Surg 2013; 8: 192
- 10 Mohiuddin K, Low DE. Functional conduit disorder complicating esophagectomy. Thorac Surg Clin 2015; 25 (04) 471-483
- 11 Kent MS, Luketich JD, Tsai W. et al. Revisional surgery after esophagectomy: an analysis of 43 patients. Ann Thorac Surg 2008; 86 (03) 975-983 , discussion 967–974
- 12 Borst HG, Dragojevic D, Stegmann T, Hetzer R. Anastomotic leakage, stenosis, and reflux after esophageal replacement. World J Surg 1978; 2 (06) 861-864
- 13 KC. M. Total Oesophagectomy—Three Staged Resection. Edinburgh (United Kingdom): Churchill Livingstone; 1988
- 14 van Lanschot JJ, van Blankenstein M, Oei HY, Tilanus HW. Randomized comparison of prevertebral and retrosternal gastric tube reconstruction after resection of oesophageal carcinoma. Br J Surg 1999; 86 (01) 102-108
- 15 Imada T, Ozawa Y, Minamide J. et al. Gastric emptying after gastric interposition for esophageal carcinoma: comparison between the anterior and posterior mediastinal approaches. Hepatogastroenterology 1998; 45 (24) 2224-2227
- 16 Gawad KA, Hosch SB, Bumann D. et al. How important is the route of reconstruction after esophagectomy: a prospective randomized study. Am J Gastroenterol 1999; 94 (06) 1490-1496
- 17 Shiraha S, Matsumoto H, Terada M, Noguchi J, Sankouji T, Hayashi M. Motility studies of the cervical esophagus with intrathoracic gastric conduit after esophagectomy. Scand J Thorac Cardiovasc Surg 1992; 26 (02) 119-123
- 18 Chen H, Lu JJ, Zhou J. et al. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study. Ann Thorac Surg 2009; 87 (02) 400-404