ABSTRACT
Oesophageal carcinoma is not uncommon. One common goal of curative and palliative resection of oesophageal carcinoma is to achieve good functional outcome. During the last decade, Ivor Lewis operation with intrathoracic oesophagogastric anastomosis has been rising as the operation of choice for lower oesophageal carcinoma. It is wdl known that no oesophageal substitute is able to function as proper as the original organ, the peristalsis of which is essential to propel food into the gastric reservoir. Many authors think that the greater the length of the remaining oesophageal stump the better the postoperative functional outcome. The aim of this work was to evaluate the functional outcome after Ivor Lewis oesophagectomy and gastric pull-up for oesophageal cancer and to correlate the results with the length of the preserved oesophageal stump. Twenty patients [15 males, mean age 60 ys] were studied at the sixth postoperative month by questionnaire, stationary manometry and upper GI endoscopy. The commonest postoperative unpleasant complaints were early postprandial sensation of fullness [70%], diarrhea [40%] and gastrooesophageal reflux disease [GORD] [40%]. GORD was more profound in the left lateral position. According to the actual site of the oesophago-gastric anastomosis away from the central incisors as seen during endoscopy, patients were classified into 2 groups: High anastomosis group [A] with anastomosis lying less than 25cm from the central incisors [i.e. the anatomical length of the oesophageal stump < 10 cm] and low anastomosis group [B] with anastomosis lying at or below 25cm from the central incisors [ie. the anatomical length of the oesophageal stump >/= 10 cm]. It has been found that in low anastomosis group, there was a significant difference between the anatomical length of oesophageal stump and the functional length [as measured by manometry]. Patients in low anastomosis group had significantly better postoperative oesophageal body functions as revealed by better mean peristaltic pressure amplitudes [37 mmHg in group B versus 20.1 mmHg in group A, P < 0.05], better duration of contractions [2.11 sec. in group B versus 1.62 sec. in group A, P < 0.05] and better propagation velocity of the muscular contractions [2.7 mm/sec, in group B versus 2.01 mm/sec, in group A, P < 0.05]. This was reflected clinically by significant increase in body weight and significantly higher proportion of patients regaining their normal preoperative body weight in the low anastomosis group. It has been concluded that, provided oncological rules are not breached, Ivor Lewis operation with low intrathoracic anastomosis gives better functional outcome than high anastomosis in patients with lower oesophageal carcinoma