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Mar 28, 2023 177 likes •314 views

Routine contrast radiology after oesophagectomy and total gastrectomy Upper Gastrointestinal Surgery Department James Cook University Hospital Middlesbrough Mr A Madhavan Ms H Wescott Mr N Jennings Mr PA Davis Mr SMD Dresner MR YKS

SLIDE 1

Routine contrast radiology after

esophagectomy and total gastrectomy

Mr A Madhavan Ms H Wescott Mr N Jennings Mr PA Davis Mr SMD Dresner MR YKS Vishwanath

Upper Gastrointestinal Surgery Department James Cook University Hospital Middlesbrough

SLIDE 2

INTRODUCTION

High morbidity and mortality

associated with anastomotic leaks

50% mortality with leaks
No role for routine contrast

swallow following gastrectomy (Lamb et al)

Still widely practiced in the UK
CT scan at 7 day improves

sensitivity and negative predictive value for diagnosing anastomotic leak (Upponi et al)

SLIDE 3

AIMS

Assessing and comparing the use of selective contrast radiography after surgery with

routine tests:

1. Detection of anastomotic leaks 2. Performance of routine radiography 3. Clinical outcome

SLIDE 4

METHODS

Retrospective study
Total gastrectomy and subtotal oesophagectomy for

malignancy

January 2006 to January 2012 (n=270)
Contrast radiography performed according to surgeon’s

preferences

Non-ionic contrast, no barium

SLIDE 5

PATIENT GROUPS

Routine contrast swallow (RS)
Selective contrast swallow (SS)

depending on clinical progression

SLIDE 6

RESULTS

Total number n = 270

Routine n = 184 Selective n = 86

SLIDE 7

PATIENT DEMOGRAPHICS

RS n=184 SS n=86 p value Age (years) 64 63 ns M:F 3:1 3.2:1 ns Day of swallow 5 (2-11) 10 (6-34) ns Oesophagectomy Total Gastrectomy 143 41 45 41

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RESULTS OF ROUTINE CONTRAST RADIOLOGY RS n = 184 n=176 Leak n = 10 No leak n = 166 Leak n = 6 Clinical leak n = 6

SLIDE 9

PERFORMANCE OF ROUTINE RADIOLOGY

Sensitivity

40%

Specificity

96%

Positive predictive value

60%

Negative predictive value

97%

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RESULTS OF SELECTIVE RADIOLOGY

SS n = 86 Swallow n = 21 No swallow n = 35 Clinical Leak n = 1 Leak n = 0

SLIDE 11

CLINICAL OUTCOMES

RS n=184 SS n=86 Post-operative stay

19 16

Anastomotic leak rate

6.7% 1.1%

In hospital mortality

1.6% 4.7%

MORTALITY 2.6% LEAKS 4.8%

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CONCLUSION

Leak rate following total gastrectomy and sub-total
esophagectomy is low
Total gastrectomy – 7%
Oesophagectomy – 4%
Mortality following resection for upper

gastrointestinal malignancy is 2.6%

Contrast swallows performed in the early post
perative period to exclude a mechanical problem

do not exclude a subsequent ischaemic breakdown

SLIDE 13

REFERENCES

1. Lamb et al. Prospective study of routine contrast radiology after total gastrectomy. Br J Surg, 2004 Aug;91(8):1015-9 2. Upponi et al. Radiological detection of post oesophagectomy anastomotic leak – a comparison between multidetector CT and

fluroscopy. Br J Radiology, 2008 Jul;81 (967):545-8

3. Boone et al. Diagnostic value of routine aqeuous contrast swallow examination after oesophagectomy for detecting leakage of the cervical oesophagogastric anastomosis. ANZ J Surg, 2008 Sep; 78(9); 784-90