222. DYSPHAGIA SCORE CAN BE A PREDICTOR OF POSTOPERATIVE ANASTOMOTIC STRICTURE: A SINGLE-CENTER RETROSPECTIVE STUDY

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Abstract Background Anastomotic stricture (AS) after esophagectomy is a major cause of long-term morbidity and a poor quality of life. Risks of AS after esophagectomy include the anastomosis methods, the occurrence of anastomotic leakage, and anatomical problems. However, there have been very few reports on the relationship between preoperative Dysphagia Score (DS) and postoperative AS. In our institution, the basic surgical procedure for esophageal cancer is video assisted thoracic surgery (VATS) of McKeown esophagectomy and retrosternal gastric tube reconstruction, and the anastomosis method is mainly selected as the circular stapler (CS). Methods Of the 56 cases of esophagectomy for esophageal cancer performed at our institution between January 2020 and the end of June 2024, we examined the clinicopathological characteristics and the presence or absence of AS that could be evaluated within 6 months after surgery in 40 cases, in which a cervical anastomosis was performed with gastric tube reconstruction. Results AS occurred in 14 cases (35%). Postoperative anastomotic leakage occurred in 6 cases (15%), but was not associated with AS. The incidence of AS in the preoperative DS0 group was 53%, whereas it was only 22% in the preoperative DS1 or higher group (p < 0.05). The mean esophageal diameter measured at the upper sternal border on CT before surgery (EDUS) was 15.2/18.7/22.3/23.3 mm in the DS0/1/2/3 groups. The cutoff value of EDUS calculated from the ROC curve was 19.5 mm, which was almost the same as the boundary value between the DS0 and DS1 or higher groups. Conclusion In reconstruction with CS for DS1 or higher, a large-diameter anvil can be inserted with a sufficient margin relative to the esophageal diameter. In addition, the fact that patients with DS1 or higher have the habit of being careful about their meals due to dysphagia may contribute to the suppression of postoperative AS symptoms. On the other hand, in the case of DS0, anastomosis methods that are less likely to cause AS should be considered. In addition, it seemed necessary to pay attention to oral intake instructions after surgery. Therefore, preoperative DS can be a predictor of AS.

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