KEY TAKEAWAYS
- The study aimed to investigate the incidence of HH and its impact on outcomes following esophagectomy in esophageal adenocarcinoma patients.
- Researchers noticed that, despite higher postoperative complications in HH patients, low positive margin rates and survival were observed in patients undergoing esophagectomy.
Esophageal adenocarcinoma risk is associated with hiatal hernia (HH) and gastroesophageal reflux disease (GERD). Patients with preoperative HH undergoing esophagectomy face high positive margin rates and poor survival. Adi Zaslavsky and the team aimed to characterize the incidence and impact of HH on outcomes of post-esophagectomy.
Researchers performed an inclusive analysis encompassing patients who underwent esophagectomy for esophago-junctional carcinoma from 2012 to 2019. CT studies underwent blind review by 2 radiologists, with a third radiologist resolving cases of disagreement. HH ≥ 3 cm were classified in the hernia group.
About 66 patients (33%) undergoing esophagectomy for esophageal-junctional carcinoma had HH ≥ 3 cm, while the no hernia group comprised 12 patients (6%) with < 3 cm HH and 106 (53%) without HH. Preoperative variables were comparable. Anastomosis location was predominantly cervical (82.2% vs 92.4%, P=0.113). Postoperatively, HH patients had a higher incidence of atrial dysrhythmia (n = 11, 16.7% vs n = 6, 5.1% P = 0.015). R0 resection rates were similar (n = 62, 93.9%, vs n = 113, 95.8%, P = 0.724). HH patients showed higher rates of signet ring cell histology (n = 14, 21.2% vs n = 9, 7.6% P = 0.025), confirmed in the adenocarcinoma subgroup analysis (n = 14, 28.6% vs n = 8, 12.3%, P = 0.042). Cox regression analysis revealed no association of HH with disease-free or overall survival (HR 1.308, P=0.274 and HR 0.905, P=0.722).
The study concluded that in patients with preoperative HH, higher rates of postoperative atrial dysrhythmias and signet ring cell features were observed. In a population with predominant cervical anastomosis, positive margin rates were low, and survival was comparable among cohorts.
Source: https://pubmed.ncbi.nlm.nih.gov/38038853/
Zaslavsky A, Solomon D, Varon D, et.al (2024). ‘’Incidence and Impact of Preoperative Hiatal Hernia in Patients with Esophageal Carcinoma Undergoing Curative Surgical Resection.’’ J Gastrointest Surg. 2023 Dec;27(12):2907-2919. doi: 10.1007/s11605-023-05872-w. Epub 2023 Dec 1. PMID: 38038853.
