Background
The population‐based incidence of anastomotic
stricture after minimally invasive oesophagectomy (MIO) and open
oesophagectomy (OO) is not known. The aim of this study was to compare
rates of anastomotic stricture requiring dilatation after the two
approaches in an unselected cohort using nationwide data from Finland
and Sweden.
Methods
All patients who had MIO or OO for oesophageal cancer
between 2007 and 2014 were identified from nationwide registries in
Finland and Sweden. Outcomes were the overall rate of anastomotic
stricture and need for single or repeated (3 or more) dilatations for
stricture within the first year after surgery. Multivariable Cox
regression provided hazard ratios (HRs) with 95 per cent confidence
intervals, adjusted for age, sex, co‐morbidity, histology, stage, year,
country, hospital volume, length of hospital stay and readmissions.
Results
Some 239 patients underwent MIO and 1430 had an open
procedure. The incidence of strictures requiring one dilatation was 16·7
per cent, and that for strictures requiring three or more dilatations
was 6·6 per cent. The HR for strictures requiring one dilatation was not
increased after MIO compared with that after OO (HR 1·19, 95 per cent
c.i. 0·66 to 2·12), but was threefold higher for repeated dilatations
(HR 3·25, 1·43 to 7·36). Of 18 strictures following MIO, 14 (78 per
cent) occurred during the first 2 years after initiating this approach.
Conclusion
The need for endoscopic anastomotic dilatation after
oesophagectomy was common, and the need for repeated dilatation was
higher after MIO than following OO. The increased risk after MIO may
reflect a learning curve.
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