Esophageal reinforcement with an extracellular scaffold during total gastrectomy for gastric cancer Journal Article

Authors: Afaneh, C.; Abelson, J.; Schattner, M.; Janjigian, Y. Y.; Ilson, D.; Yoon, S. S.; Strong, V. E.
Article Title: Esophageal reinforcement with an extracellular scaffold during total gastrectomy for gastric cancer
Abstract: Background: Esophagojejunal (EJ) anastomotic leaks after total gastrectomy (TG) for malignancy lead to significant morbidity and mortality, thus affecting long-term survival. Preclinical and clinical trials have shown promise inutilizing degradable extracellular matrix (ECM) scaffolds in buttressing anastomoses. We describe our experience buttressing the EJ anastomosis after TG with a ECM scaffold. Methods: From February 2012 to January 2014, a total of 37 consecutive patients underwent TG buttressing of the EJ anastomosis with the degradable ECM scaffold composed of a porcine urinary bladder called MatriStem (ACell Inc.). The scaffold was circumferentially wrapped around the EJ anastomosis. The primary end point was the EJ leak rate, while the secondary end point was the EJ stricture rate. Results: The mean ± SD age and body mass index were 59 ± 16 years and 28.1 ± 4.9 kg/m2, respectively. Most patients were male (51 %), white (78 %), and former smokers (51 %). Over half (59 %) underwent neoadjuvant chemotherapy. A minimally invasive TG was performed in 70 % of patients. Signet ring was the most common tumor type (48 %), and most patients had midstage disease (59 %). The mean number of lymph nodes procured was 36 ± 16. Eighteen patients (49 %) experienced a complication, mostly minor. One patient (2.7 %) developed an EJ leak, while three patients (8 %) developed an EJ stricture. Median follow-up was 7 months (range 2–12 months). There was no operative or in-hospital mortality. Discussion: The use of urinary bladder matrix scaffolds may be helpful in decreasing the incidence of EJ anastomotic leak and/or stricture. A prospective phase II trial at our institution is currently under way. © 2014, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 22
Issue: 4
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2015-04-01
Start Page: 1252
End Page: 1257
Language: English
DOI: 10.1245/s10434-014-4125-4
PROVIDER: scopus
PUBMED: 25319574
Notes: Export Date: 4 May 2015 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Sam Yoon
    55 Yoon
  2. Yelena Yuriy Janjigian
    148 Janjigian
  3. Vivian Strong
    148 Strong
  4. David H Ilson
    275 Ilson
  5. Mark Schattner
    104 Schattner
  6. Cheguevara I Afaneh
    2 Afaneh