Abstract:
Background: Placement of self-expandable metal stents (SEMS) by endoscopy has become a recommend treatment for esophagojejunal anastomotisis leakage (EJAL). There is no clear conclusion on whether neoadjuvant therapy will increase the incidence of EJAL in adenocarcinoma of the gastroesophageal junction (AEG) patients. Furthermore, there is no research on whether a prophylactic placement of SEMS during operation would prevent EJAL. Here we reported the incidence of EJAL of AEG patients in single center, and analyzed the potential clinical significance of placement SEMS in advance for the prevention of EJAL.
Methods: Retrospectively, a total of 85 patients diagnosed AEG in our center from 2017-2023 who underwent total gastrectomy were classified into 3 groups: Neoadjuvant Chemoradiotherapy (Group NCR, n=42); Chemotherapy (Group NCO, n=15); Operation only (Group OO, n=28). 11 patients in Group NCR are placed on SEMS during operation. Clinical data such as the incidence of EJAL and anastomotic stenosis(AS) of each group were analyzed.
Results: 31 cases in Group NCR were not placed SEMS (4 cases in 31 were diagnosed EJAL and treated with SEMS), 11 patients in Group NCR were placed on SEMS during operation (no patients were diagnosed EJAL). There was one case diagnosed EJAL in both Group NCO(1 of 15) and Group OO(1 of 28). The overall EJAL rate was 8.2% (6 of 85), 12.9% in Group NCR(4 of 31), 6.7% in Group NCO(1 of 15) and 3.6% in Group OO(1 of 28). The total AS incidence rate was 9.4%( 8 of 85), and no cases were diagnosed AS in patients who were preplaced SEMS.
Conclusion: The incidence of EJAL in AEG patients who underwent neoadjuvant therapy was higher than that of non- neoadjuvant therapy patients. Prophylactic placement of SEMS during operation in AEG patients who underwent neoadjuvant therapy may play a certain role in preventing EJAL.
Audience Take Away Notes:
• Neoadjuvant Chemoradiotherapy may increase the risk of anastomotisis leakage (EJAL) in adenocarcinoma of the gastroesophageal junction (AEG) patients. Patients need to be informed of the risk of EJAL complications
• Esophagojejunostomy after laparoscopic total gastrectomy is the most technically difficult type of anastomosis, Prophylactic placement of SEMS during operation in AEG patients may play a certain role in preventing EJAL
• It can be inferred that if you feel unsatisfied with esophagojejunostomy, regardless of whether neoadjuvant therapy is used or not, prophylactic placement of SEMS may be a wisdom clinical strategy in laparoscopic total gastrectomy
