| Title: |
Incidence and Risk Factors for Diaphragmatic Herniation Following Esophagectomy for Cancer |
| Authors: |
Hertault, Hugo; Gandon, Anne; Behal, Hélène; Legault, Gaëtan; Degisors, Sébastien; Martin, Louis; Messier, Marguerite; Noiret, Barbara; Vermersch, Mathilde; Nuytens, Frederiek; Eveno, Clarisse; Piessen, Guillaume |
| Contributors: |
Université des Antilles - UFR des sciences médicales Hyacinthe Bastaraud (UA UFR SM); Université des Antilles (UA); Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc); Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille; Department of Digestive and Oncological Surgery; Hôpital Claude Huriez Lille; Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille)-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS); Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 (CANTHER); Institut Pasteur de Lille; Pasteur Network (Réseau International des Instituts Pasteur)-Pasteur Network (Réseau International des Instituts Pasteur)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS) |
| Source: |
ISSN: 0003-4932. |
| Publisher Information: |
CCSD; Lippincott, Williams & Wilkins |
| Publication Year: |
2021 |
| Collection: |
LillOA (HAL Lille Open Archive, Université de Lille) |
| Subject Terms: |
[SDV.CAN]Life Sciences [q-bio]/Cancer |
| Description: |
International audience ; Objective: To evaluate the incidence and risk factors of diaphragmatic herniation following esophagectomy for cancer (DHEC), and assess the results of surgical repair. Summary Background data: The current incidence of DHEC is discussed with conflicting data regarding its treatment and natural course. Methods: Monocentric retrospective cohort study (2009–2018). From 902 patients, 719 patients with a complete follow-up of CT scans after transthoracic esophagectomy for cancer were reexamined to identify the occurrence of a DHEC. The incidence of DHEC was estimated using Kalbfleisch and Prentice method and risk factors of DHEC were studied using the Fine and Gray competitive risk regression model by treating death as a competing event. Survival was analyzed. Results: Five-year DHEC incidence was 10.3% [95% CI, 7.8%–13.2%] (n = 59), asymptomatic in 54.2% of cases. In the multivariable analysis, the risk factors for DHEC were: presence of hiatal hernia on preoperative CT scan (HR = 1.72 [1.01–2.94], P = 0.046), previous hiatus surgery (HR = 3.68 [1.61–8.45], P = 0.002), gastroesophageal junction tumor location (HR = 3.51 [1.91–6.45], P < 0.001), neoadjuvant chemoradiotherapy (HR = 4.27 [1.70–10.76], P < 0.001), and minimally invasive abdominal phase (HR = 2.98 [1.60–5.55], P < 0.001). A cure for DHEC was achieved in 55.9%. The postoperative mortality rate was nil, the overall morbidity rate was 12.1%, and the DHEC recurrence rate was 30.3%. Occurrence of DHEC was significantly associated with a lower hazard rate of death in a time-varying Cox's regression analysis (HR = 0.43[0.23–0.81], P = 0.010). Conclusions: The 5-year incidence of DHEC is 10.3% and is associated with a favorable prognosis. Surgical repair of symptomatic or progressive DHEC is associated with an acceptable morbidity. However, the optimal surgical repair technique remains to be determined in view of the large number of recurrences. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1097/SLA.0000000000005122 |
| Availability: |
https://hal.science/hal-04522454; https://doi.org/10.1097/SLA.0000000000005122 |
| Accession Number: |
edsbas.7532F2DC |
| Database: |
BASE |