Eastern Cardiothoracic Surgical Society

Comparison of Post-Operative Symptoms in Patients Undergoing Pyloroplasty, Botulinum Toxin, or No Gastric Emptying Procedure After Esophagectomy
Amanda A. Ghanie, Rachel Grosser, Nabil P. Rizk, Debra A. Goldman, Camelia S. Sima, Manjit S. Bains, Valerie W. Rusch, David R. Jones, Inderpal S. Sarkaria, Memorial Sloan Kettering Cancer Center, New York, NY

OBJECTIVE: Pyloroplasty and intra-pyloric botulinum toxin injection (BTI) are common gastric-emptying procedures performed during esophagectomy for esophageal cancer. There remains debate whether these procedures improve digestive function and quality of life (QOL). We prospectively collected patient self-reported symptoms after esophagectomy to assess for differences in patients undergoing pyloroplasty, BTI, or no gastric emptying procedure (NGE).

METHODS: We performed a secondary analysis of a prospective, non-randomized study assessing QOL after minimally invasive and open esophagectomy. We examined symptoms of cough, fullness, and reflux (any vs. none) compared by gastric-emptying procedure at the time of surgery (pyloroplasty, BTI, or NGE) using portions of the Memorial Symptoms Assessment Scale (MSAS). Differences between groups were assessed using the Kruskal Wallis test for continuous variables and fisher s exact test for categorical variables.

RESULTS: 127 patients were enrolled from 3/26/2012-1/31/2014 with 37 having pyloroplasty, 32 BTI, and 58 NGE. No differences were found between groups for age, gender, stage or ASA score (p>0.05) (Table 1). Fewer patients undergoing pyloroplasty reported cough and fullness compared to the other groups (Figure 1). Fewer patients undergoing BTI and NGE reported symptomatic reflux than in the pyloroplasty group at 4 months post-operatively (32% and 41% vs 52%). Rates of anastomotic leak and major complications were similar between the three groups.

CONCLUSIONS: Rates of self-reported reflux may be increased in patients undergoing pyloroplasty after esophagectomy. Further randomized studies may be necessary to better determine the impact of various gastric-emptying strategies on QOL after esophagectomy for cancer.