ABSTRACT
Background: Surgery is the most effective treatment for the resectable esophageal cancer of the middle & lower third and gastro-esophageal junction (GEJ) tumors. We hereby scrutinise our experience in minimally invasive esophageal surgery (MIES) to evaluate its safety and efficacy as an oncosurgical procedure. Methods: The study included99consecutive patients. Depending on the location of the tumor, either thoracoscopic transthoracic esophagectomy (TTE) in prone position or laparoscopic transhiatal esophagectomy (THE) was planned. 2 field comprehensive nodal dissection were part of both the surgical procedures. Results: 05 patients were excluded, 18 were inoperable and 12 had open surgery. 64 underwent MIES (THE-37, TTE-27), Male: Female-31:33. Nodal Harvest (nodes): THE-14.27, TTE-14.77. Margins (cm): THE-proximal (P) - 6.70, distal (D) -2.51, TTE: (P)-5.41, (D)-5.11. 30 days Morbidity (26): cervical leak-05, left vocal cord palsy-05, tracheostomy-03, respiratory insufficiency-03, aspiration-01, chyle leak-01, exploratory laparotomy-01, cardiac-02, stroke-01, surgical emphysema -01, abdominal wound Infection -03 30 days Mortality (1) –pulmonary embolus. Operative time (minutes): THE-234, TTE-322. Blood loss (ml/patient): THE-265, TTE-380. Hospital stays (days): THE-7.3, TTE-10. Conclusions: 79% of properly selected & evaluated cases underwent MIES, with one Mortality and 26 events of morbidity. 6% required conversion. The procedure detected inoperability in 16% cases. The nodal yield, status of margins, operative time, blood loss and hospital stay indicates that MIES has a future to become a standard of care in the treatment of esophageal cancers.
ABSTRACT
Hemorrhage into the esophagus due to aortoesophageal communication is very rare but life-threatening with high morbidity and mortality. Because of this, most cases of aortoesophageal fistula are confirmed by autopsy. However, we report herein a case of a 62-year-old male with an aortoesophageal fistula who was successfully treated with endovascular stent-grafting. The patient had undergone esophageal stent insertion due to esophageal cancer and experienced hematemesis and hemodynamic shock due to an aortoesophageal fistula. Emergency endoscopy was unable to identify the source of the hemorrhage due to massive bleeding. Computed tomography of the chest revealed a focal pseudoaneurysm at the descending aorta and diffuse thinning of the esophageal wall, which were treated with endovascular stent-grafting. Although aortoesophageal fistulas are usually fatal, implantation of a covered stent into the esophagus may help prevent massive bleeding, providing valuable time to treat the patient.