Journal of the American College of Surgeons · 2026
Defining Clinically Significant Radiographic Recurrence after Paraesophageal Hernia Repair: Post Hoc Analysis of Patient-Reported Outcomes and Reoperation from a Randomized Controlled Trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Bennett William C, Ellis Ryan C, Mohamed Mahamed O, Conner Andrew S, Tu Chao, Miller Benjamin T, Beffa Lucas R, Krpata David M, Rosen Michael J, Prabhu Ajita S, Petro Clayton C
Аннотация
BACKGROUND: Radiographic recurrence after minimally invasive paraesophageal hernia repair (MIS-PEHR) is frequently defined as more than 2 cm of gastric herniation above the diaphragm, although this threshold was historically pragmatic rather than outcomes based. We evaluated whether recurrence size correlates with reoperation and patient-reported outcomes to support a clinically meaningful definition.
STUDY DESIGN: Post hoc analysis of a prospective randomized clinical trial (NCT04007952) including adults with paraesophageal hernia more than 5 cm undergoing MIS-PEHR (June 2019 to July 2023). Of 234 patients eligible for 1-year follow-up, 174 (74.4%) had imaging and reoperation data. Recurrence was categorized as 0 cm (n = 111), 0 to 2 cm (n = 10), 2 to 5 cm (n = 40), or more than 5 cm (n = 13). Outcomes included reoperation within 1 year and GERD Health-Related Quality of Life and Foregut-Associated Symptoms Likert scores.
RESULTS: Six patients (2.5%) underwent reoperation. No reoperations occurred with recurrence less than 2 cm; rates were 7.5% (3 of 40) for 2 to 5 cm and 23.1% (3 of 13) for more than 5 cm recurrences (p < 0.0001). Median GERD Health-Related Quality of Life total score was 3.0 [1.0 to 5.0] for 0 cm, 6.0 [3.0 to 16.0] for 2 to 5 cm (p = 0.0001 vs 0 cm), and 14.5 [2.0 to 32.0] for more than 5 cm (p = 0.0026 vs 0 cm); 0 to 2 cm recurrences did not differ from 0 cm (p = 0.13). Heartburn scores were similarly higher in both more than 2 cm groups (p ≤ 0.0005). Total Foregut-Associated Symptoms Likert scores differed across groups (p = 0.019), driven by worse symptoms in the more than 5 cm group. No differences were observed between the 2 to 5 cm and more than 5 cm groups.
CONCLUSIONS: Radiographic recurrence more than 2 cm was associated with higher reoperation rate and worse patient-reported outcomes at 1 year, whereas 0 to 2 cm recurrences were not. These data support more than 2 cm as a clinically significant definition of recurrence after MIS-PEHR, whereas the relevance of smaller recurrences remains uncertain.
STUDY DESIGN: Post hoc analysis of a prospective randomized clinical trial (NCT04007952) including adults with paraesophageal hernia more than 5 cm undergoing MIS-PEHR (June 2019 to July 2023). Of 234 patients eligible for 1-year follow-up, 174 (74.4%) had imaging and reoperation data. Recurrence was categorized as 0 cm (n = 111), 0 to 2 cm (n = 10), 2 to 5 cm (n = 40), or more than 5 cm (n = 13). Outcomes included reoperation within 1 year and GERD Health-Related Quality of Life and Foregut-Associated Symptoms Likert scores.
RESULTS: Six patients (2.5%) underwent reoperation. No reoperations occurred with recurrence less than 2 cm; rates were 7.5% (3 of 40) for 2 to 5 cm and 23.1% (3 of 13) for more than 5 cm recurrences (p < 0.0001). Median GERD Health-Related Quality of Life total score was 3.0 [1.0 to 5.0] for 0 cm, 6.0 [3.0 to 16.0] for 2 to 5 cm (p = 0.0001 vs 0 cm), and 14.5 [2.0 to 32.0] for more than 5 cm (p = 0.0026 vs 0 cm); 0 to 2 cm recurrences did not differ from 0 cm (p = 0.13). Heartburn scores were similarly higher in both more than 2 cm groups (p ≤ 0.0005). Total Foregut-Associated Symptoms Likert scores differed across groups (p = 0.019), driven by worse symptoms in the more than 5 cm group. No differences were observed between the 2 to 5 cm and more than 5 cm groups.
CONCLUSIONS: Radiographic recurrence more than 2 cm was associated with higher reoperation rate and worse patient-reported outcomes at 1 year, whereas 0 to 2 cm recurrences were not. These data support more than 2 cm as a clinically significant definition of recurrence after MIS-PEHR, whereas the relevance of smaller recurrences remains uncertain.