Artikel
Incidence and risk factors of hiatal hernia following resection for gastric and esophageal cancer
Suche in Medline nach
Autoren
-
Matthias Biebl
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Andreas Andreou
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Sven-Christian Schmidt
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Benjamin Struecker
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Mehran Dadras
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Igor Sauer
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Sascha Chopra
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Panagiotis Fikatas
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
-
Johann Pratschke
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Berlin, Deutschland
| Veröffentlicht: | 21. April 2016 |
|---|
Gliederung
Text
Background: Hiatal hernia (HH) following resection for gastric or esophageal cancer is a potentially life-threatening event that my lead to emergent surgery. However, the incidence and risk factors of this complication remain unclear.
Materials and methods: Data of patients who underwent resection for gastric or esophageal cancer between 2005 and 2012 were assessed and the incidence of HH was evaluated. In addition, we investigated factors associated with an increased risk for the development of HH.
Results: During the study period, 471 patients underwent resection for gastric or esophageal cancer. The primary tumor was located in the stomach, cardia and esophagus in 36%, 24%, and 40% of the patients, respectively. After a median follow-up time of 35 months, the incidence of HH was 2.8% (n = 13 patients). The median interval between gastric or esophageal resection and the diagnosis of HH was 15 (0.1-57) months. All patients underwent surgical hernia repair, 8 patients (61.5%) required an emergent procedure and 3 patients (23%) underwent bowel resection. Postoperative morbidity and mortality after HH repair was 38.5% and 7.7%, respectively. Factors associated with an increased risk for HH included Body-Mass-Index (BMI) (median BMI 27 [23-35] with HH vs. 25 [15-51] without HH, P = .043), diabetes (HH rate: diabetes, 6.3% vs. no diabetes, 2%, P = .034), tumor location (HH rate: gastric cancer, 1.2% vs. esophageal cancer, 1.1% vs. cardia cancer, 7.9%, P = .001), and the resection type (HH rate: total/subtotal gastrectomy, 0.7% vs. transthoracic esophagectomy, 2.7% vs. extended gastrectomy, 6.1%, P = .038).
Conclusion: HH is a major adverse event after resection for gastric or esophageal cancer especially among obese patients with diabetes undergoing extended gastrectomy for cardia cancer. Intensive follow-up examinations for high-risk patients and early diagnosis of asymptomatic patients are essential for the selection of appropriate candidates for elective surgical treatment in order to avoid unpredictable emergent events with high morbidity and mortality.
