Paraconduit hernia after minimally invasive esophagectomy – incidence and risk factors

Figures & data

Figure 1. Cumulative hazard of paraconduit hernia after minimally invasive esophagectomy for esophageal and esophagogastric junction adenocarcinoma.

Table 1. Demographics of patients who underwent MIE after neoadjuvant treatment for esophageal and esophagogastric junction adenocarcinoma.

		All	Paraconduit hernia
		n (%)	n (%)
Sex	Female	32 (18.7)	1 (7.1)
	Male	139 (81.3)	13 (92.9)
Age	Mean (SD)	63.8 (9.4)	64.3 (9.4)
BMI	Mean (SD)	25.3 (4.8)	22.2 (2.9)
ECOG	0	122 (71.3)	11 (78.6)
	1	48 (28.1)	3 (21.4)
Location	Middle esophagus	2 (1.2)	0 (0)
	Distal esophagus	57 (33.3)	4 (28.6)
	GE-junction/cardia	112 (65.5)	10 (71.4)
Preoperative treatment	Chemotherapy	160 (93.6)	10 (71.4)
	Chemoradiotherapy	10 (5.8)	3 (21.4)
	Radiotherapy	1 (0.6)	1 (7.1)
Operation type	Ivor Lewis	166 (97.1)	13 (92.9)
	McKeown	3 (1.8)	1 (7.1)
	Transhiatal	1 (0.6)	0 (0)
	Roux-en-Y	1 (0.6)	0 (0)
Approach	MIE	160 (93.6)	14 (100)
	Hybrid	10 (5.8)	0 (0)
	Laparoscopic transhiatal	1 (0.6)	0 (0)
Conversion		15 (8.8)	0 (0)
Major complication		44 (25.7)	2 (14.3)
Lymph nodes	Mean (SD)	20.7 (10.3)	20.5 (8.7)
Preoperative hernia		37 (21.6)	1 (2.7)
Preoperative esophagus stent		52 (30.4)	7 (50)

Figure 2. Hernia free survival based on preoperative radiotherapy.

Figure 3. Hernia free survival based on BMI.

Table 2. Risk factors for paraconduit hernia development.

	OR	95% CI	p
Univariate
Age	1.01	0.95–1.07	.826
Male sex	0.31	0.02–1.66	.271
BMI over 25	0.83	0.69–0.97	.027
Major complication	0.46	0.07–1.76	.317
Preoperative stent	2.49	0.81–7.67	.105
Conduit sutured to crura	0.57	0.16–2.65	.411
Preoperative radiotherapy	8.57	1.98–33.8	.002
Preoperative sarcopenia	2.72	0.71–17.9	.201
Multivariate
Age	0.96	0.89–1.03	.269
Male sex	1.08	0.04–1.82	.958
BMI over 25	0.82	0.65–1.00	.075
Major complication	0.45	0.06–2.25	.372
Preoperative stent	2.83	0.60–1.52	.196
Conduit sutured to crura	0.27	0.04–2.29	.183
Preoperative radiotherapy	16.0	2.11–14.4	.008
Preoperative sarcopenia	3.10	0.42–4.21	.330

Table 3. Characteristics of paraconduit hernia repair operations.

		n	(%)
Time from primary operation	<90 days	1	(10.0)
	90–365 days	2	(20.0)
	>365 days	7	(70.0)
Symptomatic		5	(50.0)
Technique	Laparoscopy	9	(90.0)
	Conversion	1	(11.1)
	Laparotomy	1	(10.0)
Urgency	Elective	7	(70.0)
	Emergency	3	(30.0)
Repair	Hiatoplasty and fixation	4	(40.0)
	Hiatoplasty	1	(10.0)
	Fixation of graft	1	(10.0)
	Mesh	4	(40.0)
Hernia type	Colon	7	(70.0)
	Small bowel	2	(20.0)
	Colon and small bowel	1	(10.0)
Bowel resection		0	(0.0)
Complication		1	(10.0)
90-day mortality		1	(10.0)