Early Postoperative Outcomes Of Pyloric Drainage In Minimally Invasive Esophagectomy
Tamar Nobel, Arianna Barbetta, Daniela Molena.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Introduction: The optimal management of the pylorus after esophagectomy with gastric conduit remains controversial. Surgeon experience with minimally invasive esophagectomy (MIE) is increasing; however, pyloric drainage in this setting may be more technically challenging than in the open approach. Intrapyloric injection of botulinum toxin has become an increasingly popular alternative to surgical drainage procedures (pyloroplasty/pyloromyotomy). Data are lacking to demonstrate whether one technique is safest in MIE. The purpose of this study was to compare early postoperative complications after MIE in patients undergoing intrapyloric botulinum injection and surgical drainage. Methods: We performed a retrospective review of a prospectively maintained database of patients with esophageal cancer undergoing MIE at a single academic institution. Patients were divided into two groups for analysis; intrapyloric botulinum toxin injection and surgical drainage (pyloroplasty or pyloromyotomy). The primary outcome was any complication within 30 days of surgery; secondary outcomes included oncological and operative data, length of stay, and mortality. Results: There were 223 MIE performed between January 2011 and May 2017; of these, 99 (44.4%) had any drainage (surgical or botulinum injection). With respect to drainage technique, 68 (30.5%) had surgical drainage and 31 (13.9%) received botulinum injection. The groups were similar with respect to age, gender, American Society of Anesthesiology Score and body mass index. Patients who received botulinum toxin had a higher incidence of pulmonary comorbidities (25.8% vs 7.4%; p=0.016). Additionally, there were no differences between groups in preoperative neoadjuvant treatment and cancer stage. The majority of cases were performed with a laparoscopic approach (85/99, 85%), and the robot was used in the remainder. Operative time and estimated blood loss were similar between groups. There was no difference in postoperative complications between groups, readmission within 30 days or length of stay. While 5 patients in the surgical drainage group needed reoperation, this was not significant. Conclusions: Drainage technique did not impact early postoperative complications after MIE. Surgeon preference and technical capabilities should determine which approach to use.
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