Resultados de la cirugía de sustitución esofágica con tubo gástrico invertido vía ascenso retroesternal en dos hospitales pediátricos / Results of esophageal substitution surgery with inverted gastric tube via retrosternal lift

Resumen Objetivo: Describir resultados de la cirugía de sustitución esofágica con tubo gástrico invertido, vía ascenso retroesternal en dos hospitales pediátricos durante el período marzo 2015 a marzo 2018. Materiales y Método: Un estudio observacional, transversal, con recolección de datos retrospectivo, donde se incluyeron todos los expedientes de pacientes que presentaban patología del esófago por causa adquirida o congénita que fueron operados de sustitución esofágica con tubo gástrico invertido en dos hospitales pediátricos durante 3 años. Resultados: Encontramos 29 niños sometidos a sustitución esofágica, de los cuales 27 cumplieron criterios de inclusión. La edad comprendida entre 2 y 17 años. El 63% corresponde al sexo femenino. La causa más frecuente de sustitución esofágica es por estenosis esofágica por ingesta caustica (92,59%). El 70% presentó algún tipo de complicación luego de la cirugía. La fístula esofagocutánea es la complicación principal con 33,33%. La permanencia en la unidad de cuidados intensivos es menor de 24 horas en un 74% de los niños. Se inicia la vía oral en casi la mitad de casos entre los 10-12 días de posquirúrgico, la estancia hospitalaria es en promedio 18,5 días. La mortalidad es 3,7%. Conclusión: La sustitución esofágica por tubo gástrico invertido vía ascenso retroesternal, es una técnica comparable en resultados a la interposición de colón. Para los autores, el estómago es un órgano ideal para realizar la reconstrucción esofágica, y sus complicaciones son manejables.

Aim: To describe the results of esophageal replacement surgery with an inverted gastric tube via retrosternal ascent in two pediatric hospitals during the period March 2015 to March 2018. Materials and Method: an observational, cross-sectional study with retrospective data collection that included all the records of patients with esophageal discontinuity due to acquired or congenital causes who underwent esophageal replacement surgery with an inverted gastric tube in two pediatric hospitals for 3 years. Results: We found 29 children undergoing esophageal replacement, of which 27 met inclusion criteria. The age between 2 to 17 years. 63% corresponds to the female sex. The most frequent cause of esophageal replacement is esophageal stricture due to caustic ingestion (92.59%). 70% presented some type of complication after surgery. The esophagocutaneous fistula is the main complication with 33.33%. The stay in the intensive care unit is less than 24 hours in 74% of children. The oral route is started in almost half of cases between 10-12 days after surgery; the hospital stay is on average 18.5 days. Mortality is 3.70%. Conclusión: The esophageal substitution by inverted gastric tube via retrosternal ascent is a technique comparable in results to the interposition of the colon. For the authors, the stomach is an ideal organ to perform esophageal reconstruction, and its complications are manageable.

The core technology of salvage resection of cervical esophageal cancer: from total laryngo-pharyngeal resection to mediastinal tracheostomy / 中华消化外科杂志

The current primary treatment of cervical esophageal cancer is still the definitive chemoradiotherapy. Salvage esophagectomy is recommended for patients who have failed the therapy. Cervical esophageal cancer is closely adjacent to the surrounding important organs, and the boundaries of regional tissues become more blurred after radiotherapy, which pose a great challenge to surgical treatment. Successful completion of this operation requires a comprehensive grasp of various surgical techniques such as total larynx, pharynx, esophagus, partial tracheal resection and respective reconstruction. The author introduces several core issues of this operation, such as tumor resection, digestive tract reconstruction, airway reconstruction, and lymph node dissection, in order to provide references for domestic colleagues, improve the success rate of surgery, and reduce the occurrence of fatal complications.

Stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofagogástricas / Self-expanding metal stents for endoscopic management of esophageal and gastric fistulas

Resumen Objetivos: mostrar la eficacia y seguridad de los stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofágicas. Materiales y métodos: se evalúo una serie de casos de manera retrospectiva entre el 2007 y el 2017, en los que se manejaron a 11 pacientes con un stent metálico autoexpandible para el manejo de fístula esofágica, en quienes se realizó el diagnóstico por clínica, endoscopia digestiva alta o estudios radiológicos en la unidad de gastroenterología del Hospital Universitario San Ignacio (HUSI) de Bogotá D. C., Colombia. Resultados: el principal síntoma inicial fue la disnea en 27,3 % de los casos, seguido por tos en un 18,2 %. El hallazgo más frecuentemente encontrado durante el seguimiento fue el derrame pleural en el 36,4 %, se realizó el diagnóstico de fístula en el 45,5 % con esofagograma y el tipo de lesión más reportada fue la fuga en la anastomosis esofagoentérica, con un 45,5 %, seguida de la esofagopleural, con un 36,4 %; y estos pacientes fueron manejados con un stent metálico autoexpandible. En el 100 % hubo éxito técnico y la resolución del defecto se evidenció en el 72,7 % de los casos. La única complicación reportada fue el desplazamiento del stent en el 27,3 %, y en un paciente se requirió el cambio del stent en 3 oportunidades. El promedio de estancia hospitalaria fue de 41,5 días. Conclusiones: el manejo endoscópico de las fístulas esofagogástricas con stents metálicos autoexpandibles es efectivo y seguro, con una baja tasa de complicaciones.

Abstract Objective: To demonstrate the efficacy and safety of self-expanding metal stents for endoscopic management of esophageal fistulas. Materials and methods: Retrospective case series between 2007 and 2017. A total of 11 patients were treated with self-expanding metal stents for esophageal fistula management, after being diagnosed based on symptoms, upper endoscopy, and/or radiological studies in the gastroenterology unit of the Hospital Universitario San Ignacio (HUSI) in Bogotá D.C, Colombia. Results: The most common initial symptom was dyspnea in 27.3% of cases, followed by cough in 18.2%. The most frequent finding during follow-up was pleural effusion in 36.4% of the cases, of which 45.5% received a diagnosis of fistula through esophagogram. The most reported lesion was esophagoenteric anastomotic leak with 45.5%, followed by esophagopleural injury with 36.4%; these patients were those who received self-expanding metal stent management. Technical success was achieved in 100% of the cases, and the defect was resolved in in 72.7% of them. The only complication reported was stent migration in 27.3%, requiring 3 changes in 1 patient. The average hospital stay was 41.5 days. Conclusions: Endoscopic management of esophagogastric fistulas with self-expanding metal stents is effective and safe, with a low complication rate.

Lymph Node Status after Neoadjuvant Chemoradiation Therapy for Esophageal Cancer according to Radiation Field Coverage / 대한흉부외과학회지

BACKGROUND: To explore the effect of radiation on metastatic lymph nodes (LNs) after neoadjuvant chemoradiation therapy (nCRT), we examined the metastatic features of LNs according to their inclusion in the radiation field. METHODS: The patient group included 88 men and 2 women, with a mean age of 61.1±8.1 years, who underwent esophagectomy and lymphadenectomy after nCRT. Dissected LNs were compared in terms of clinical suspicion of metastasis, nodal station, and inclusion in the radiation field. RESULTS: LN positivity did not differ between LNs that were inside (in-field [IF]) and outside (out-field [OF]) of the radiation field (IF: 40 of 465 [9%], OF: 40 of 420 [10%]; p=0.313). In clinical N+ nodal stations, IF stations had a lower incidence of metastasis than OF stations (IF/cN+: 16 of 142 [11%], OF/cN+: 9/30 [30%]; p=0.010). However, in clinical N- nodal stations, pathological positivity was not affected by whether the nodal stations were included in the radiation field (IF/cN-: 24 of 323 [7%], OF/cN-: 31 of 390 [8%]; p=0.447). CONCLUSION: Radiation therapy for nCRT could downstage clinically suspected nodal metastasis. However, such therapy was ineffective when used to treat nodes that were not suspicious for metastasis. Because significant numbers of residual metastases were identified irrespective of coverage by the radiation field, lymphadenectomy should be performed to ensure complete removal of residual nodal metastases after nCRT.

Analysis of prognosis of aged esophageal cancer patients after esophagectomy / 上海交通大学学报（医学版）

Objective·To investigate factors affecting the prognosis of aged esophageal cancer patients after esophagectomy.Methods·Clinical data of 103 aged patients (≥ 80 years old) undergoing esophageetomy were collected.Effects of age,sex,clinical manifestations,pre-operative diseases,post-operative complications,T stage,lymph node metastasis,maximum diameter and location of the tumor,and surgical methods on the post-operative survival were analyzed.Results·1,3,and 5 years survival rates of 103 patients were 63.2％,15.9％,and 2.7％,respectively.Kaplan-Meier survival curve analysis indicated that the post-operative survival was significantly higher in patients with T1 and T2 stages than in patients with T3 stage.The 3 and 5 y survival rates of patients with T 1 stage were 50％ and 25％,respectively.Results of Cox regression multivariate analysis showed that T stage,maximum diameter of tumor,postoperative complications,and lymph node metastasis were independent factors affecting the post-operative survival.Conclusion·Esophageal cancer patients aged over 80 years with smaller tumor diameters,less postoperative complications,and negative lymph node metastasis have a longer post-operative survival period.Esophagectomy for patients with earlier stages (T1 and T2) can achieve an ideal post-operative survival period.

The impact of depth of submucosal invasion on lymph node metastasis in TI b Esophageal Squamous Cell Carcinoma / 中华胸心血管外科杂志

Objective More early esophageal cancers are treated by endoscopy.However,whether submucosal patients are suitahle for endoscopic treatment is still controversial,and few domestic researches were conducted in this area.The present study investigated the impact of submucosal invasion depth on lymph node metastasis.Methods A total of 258 patients who underwent esophagectomy from November 2009 to March 2014 were studied.Submucosal invasion was equally categorized into inner one-third(sml),middle one-third(sm2),and deep one-third(sm3) invasion by pathologists.Demographics of patients,tumor characteristics,and surgical information were retrospectively collected through medical records.They were compared according to different submucosal invasions.Cancer characteristics and its association with LNM were analyzed by univariate and multivariate analysis.Results The study included 75 sml (29.1％),73 sm2(28.3％),and 110 sm3(42.6％) patients,and the rates of LNM were 12.0％ (9/75),11.0％ (8/73),20.9％ (23/110),respectively.sm3 might be associated with regional LN M (univariate analysis,P =0.041).Tumor volume ＞ 1.856 cm3 (P =0.022) and lymphovascular invasion (P =0.004) predicted LNM using multivariate analysis.Conclusion Submucosal ESCC showed a substantial rate of LNM and it seems that they are not suitable for endoscopic treatment.Depth of invasion was not an independent risk factor for LNM.

Tratamiento quiúúrgico del megaesófago sigmoideo, grado iv por acalaiia / Surgicaltreatmennt of sigmoid megaesophagus, achalasia by grade iv

La Acalasia presenta ausencia del peristaltismo esofágico, falta de relajación del esfínter esofágico Inferior y una zona de alta presión en el esófago distal, con compromiso del plexo mioentérico y degeneración ganglionar, determinan alteraciones severas en la deglución. Para el tratamiento quirúrgico se han propuesto múltiples técnicas operatorias con la finalidad de restablecer la alimentación oral en pacientes que presentan dificultad del pasaje de los mismos. En el Instituto Gastroenterológico Boliviano Japonés - de La Paz se ha incluido 4 pacientes con diagnóstico de Acalasia en el grado IV avanzado, con diversos grados de afectación nutricional. (3 pacientes por enfermedad chagásica y 1 paciente afectado por estenosis cáustica del esófago distal), edad comprendida entre los 45 y 60 años. Se realizo esofagoectomía distal y anastomosis esófago - gástrica T-T . resección del esófago distal con acalasia, y a nivel del área dilatada del esófago una anastomosis con el fondo gástrico T-T, con piloroplastia añadida. Dos casos con yeyunostomía de alimentación preoperatoria. Los resultados postoperatorios son altamente satisfactorios, seguimiento de 7 meses y 12 meses, con controles clínicos, radiológicos contrastados y endoscopia, se comprobó tubolización del estómago ascendido, con buena tolerancia a la dieta y ausencia de reflujo gastroesofágico. El procedimiento quirúrgico utilizado con morbimortalidad ausentes, es un aporte de la medicina boliviana, ya que no se han descrito técnicas similares en la revisión de la literatura mundial y con una ventaja clara frente a las técnicas quirúrgicas clásicas, en los que la esofagoectomía total tiene un alto riesgo para el tratamiento de la acalasia de grado avanzado.

Achalasia presents The absence of esophageal peristalsis, lack of Lower Esophageal sphincter relaxation and an area of high pressure in the distal esophagus, with involvement of the myentericplexus and ganglionic degeneration, determines severe alterations in swallowing. For surgical treatment multiple operative techniques have been proposed with the aim of restoring oral feeding in patients who have difficulty passage thereof. In the Japanese-Bolivian Gastroenterological Institute of city La Paz- Bolivia, inclusion of 4 patients diagnosed with achalasia in grade IV advanced, with varying degrees of nutritional impairment. (3 patients for Chagas disease and 1 patient affected by distal esophageal caustic stenosis), aged between 45 and 60 años. The esofagoectomy distal anastomosis performed esophageal - gastric TT. with resection distal esophagus with achalasia, dilated area level and esophageal anastomosis with the gastric fundus TT, with pyloroplasty. Twos cases with preoperative feeding jejunostomy. Postoperative results are highly satisfactory, follow up of 7 months and 12 months, with clinical, radiological and endoscopic contrasted, the stomach was found tube promoted, with good tolerance to the diet. The surgical procedure used morbidity absent, is contributed Bolivian medicine since no similar techniques are described in the review of the world literature a clear advantage over conventional surgical techniques, in which the aggregate has esofagoectomy a high risk for the treatment of achalasia of advanced degree.

Successful Management of Atrio-Esophageal Fistula after Cardiac Radiofrequency Catheter Ablation

An increase in cardiac radiofrequency catheter ablation for treating refractory atrial fibrillation has resulted in an increased prevalence of complications. Among numerous complications of radiofrequency catheter ablation, atrio-esophageal fistula, although rare, is known to have fatal results. We report a case of successful management of an atrio-esophageal fistula as a complication of cardiac radiofrequency catheter ablation.

Application of Three-dimensional Reconstruction in Esophageal Foreign Bodies

This study was conducted to investigate the clinical application of three-dimensional (3D) reconstructed computed tomography (CT) images in detecting and gaining information on esophageal foreign bodies (FBs). Two patients with esophageal FBs were enrolled for analysis. In both cases, 3D reconstructed images were compared with the FB that was removed according to the object shape, size, location, and orientation in the esophagus. The results indicate the usefulness of conversion of CT data to 3D images to help in diagnosis and treatment. Use of 3D images prior to treatment allows for rapid prototyping and surgery simulation.

Staged Repair of Esophageal Atresia with Tracheoesophageal Fistula in a Very Low-birth-weight Infant: A case report / 대한흉부외과학회지

There are still some controversies in treatment strategy for the very low-birth-weight baby with esophageal atresia even though the result of primary repair has been improving. We report a successful end to end anastomosis with staged approach in one of twin weighing 1,270 g at birth.

Double Bypass of Esophagus and Descending Thoracic Aorta for the Treatment of Esophagopleural and Aortopleural Fistula / 대한흉부외과학회지

We report here on a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an infected aortic aneurysm and an aortopleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distal ligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.

Pleural Incarceration of the Transverse Colon after Transthoracic Esophagectomy: A case report / 대한흉부외과학회지

A 65 year-old man, who underwent transthoracic esophagectomy for mid-thoracic esophageal squamous cell carcinoma, suffered from an incarcerated herniation of the transverse colon through a defect in the left mediastinal pleura. The patient had a gas collection in the left lower lung field and this then insidiously progressed; the final result was total collapse of the left lung and hemodynamic compromise. The life-threatening herniation of the transverse colon into the pleural cavity after pervious esophagectomy was corrected by emergency laparotomy. Postoperative pulmonary complications after esophagectomy can induce potentially lethal transhiatal herniation because of the danger of intestinal obstruction or strangulation. The optimal approach to transhiatal herniation after esophagectomy is prevention.

Dissecting Intramural Hematoma of the Esophagus: A case report / 대한흉부외과학회지

Dissection intramural hematoma of the esophagus (DIHO) is a rare, but well-documented condition that is part of the spectrum of acute esophageal injuries; these include the more common Mallory-Weiss tear and Boerhaave's syndrome. This disorder is predominantly seen in women during their sixth or seventh decade and the disease has various etiologies, but the pathogenesis has yet to be clarified. The triad of symptoms for this disorder includes retrosternal pain, hematemesis and odynophagia. It is important to differentiate esophageal submucosal dissection form other disorders that have a similar appearance, such as Mallory-Weiss syndrome and esophageal perforation because the prognosis of DIHO is excellent with conservative therapy and these other diseases require surgical treatment. We report here on a case of a dissecting intramural hematoma of the esophagus that was preoperatively misdiagnosed as the submucosal tumor of the esophagus preoperatively, and it was confirmed by Video-assisted thoracic surgery.

Experience with a Safe Anastomotic Method for Ivor Lewis Operation / 대한흉부외과학회지

BACKGROUND: When it comes to esophageal cancer operations, the prevalence of anastomotic complications that adversely affect quality of life is related to the type of anastomotic procedure and the operative site. We studied outcomes related to a safe anastomotic method used in Ivor Lewis esophagogastrectomy for preventing anastomotic leakage and stricture formation. MATERIAL AND METHOD: Between May 2003 and April 2007, 18 patients with esophageal cancer underwent this type of esophagogastrectomy. Four people were lost to follow-up. There were 17 men (94.4%) and 1 woman. The mean patient age was 61 years (range, 46~73 years). RESULT: The mean follow-up period was 17.2 months (range, 1~45 months). There was no anastomotic leakage. There was one benign anastomotic stricture (5.6%) requiring esophageal balloon dilatation, which was accomplished with a 25 mm circular stapler. CONCLUSION: We experienced relatively good postoperative results using a safe anastomotic method in the Ivor Lewis operation for preventing anastomotic complications. These results suggest that this anastomotic method is effective in reducing the incidence of benign anastomotic complications.

Secondary Esophageal Reconstruction for Esophageal Atresia / 대한흉부외과학회지

Jejunum and fasciocutaneous and myocutaneous flaps are theoretically recommended as esophageal substitutes in reconstruction of the esophagus after several occurrences of failed reconstruction. However, other esophageal substitutes should also be considered. Secondary esophageal reconstruction was successfully performed on a 24-year- old woman who had a history of cervical, thoracic, and abdominal operations and esophageal stricture secondary to several failed reconstructions for esophageal atresia and tracheo-esophageal fistula 21 years prior. The esophageal reconstruction was done subcutaneously by end-to-side anastomosis at the left cervical area using a deformed stomach graft. The patient was discharged with the ability to consume a regular diet after the operation.

Surgical Treatment for Cervical Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: The incidence of cervical esophageal cancer is low compared with that of thoracic esophageal cancer, and the role of surgery for cervical esophageal cancer is limited compared with that of radiotherapy or chemotherapy. This study was carried out to determine the outcome of surgery for cervical esophageal cancer. MATERIAL AND METHOD: We analyzed retrospectively medical records of 43 patients who had undergone curative surgical resection for cervical esophageal cancer from January 1989 to December 2002. Follow-up loss was absent and the last follow-up was carried out in February 28, 2004. RESULT: The mean age was 60 years old and the male to female ratio was 40:3. Histologic types were squamous cell carcinoma 42 patients and malignant melanoma 1 patient. The methods used for esophageal reconstruction were gastric pull-up 32 patients, free jejunal graft 7 patients and colon interposition 4 patients. Postoperative complications occurred in 31 patients (72%), and operative mortality occurred in 7 patients (16%). Pathologic stages were I 3, IIa 14, IIb 1, III 19, and IVa 6 patients. Tumor recurrence occurred in 16 patients (44%), and the 3 and 5-year survival rates were 29.3% and 20.9%. CONCLUSION: The reported surgical results for cervical esophageal cancer showed somewhat high operative mortality, postoperative complication rates and recurrence rates and a low long-term survival rate. It is suggested that multimodality treatment including surgery is needed for the treatment of cervical esophageal cancer because radiotherapy or chemotherapy without surgery could not relieve dysphagia or resolve the tumor completely.

The Role of Surgery for the Treatment of Upper Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: In the past, radiotherapy was the gold standard for the treatment of upper esophageal cancer, but the long-term follow-up was disappointing. There is still ongoing debate on the surgical management of these patients. This study was undertaken to update our experience with upper esophageal carcinoma and to evaluate the effectiveness of surgery. MATERIAL AND METHOD: From May 1995 to December 2005, 147 patients with esophageal cancer underwent surgery at our hospital. They were divided into two groups: one group consisted of 23 patients with upper esophageal (cervical and upper thoracic) cancer and another group consisted of 124 patients with lower esophageal (middle thoracic, lower thoracic and abdominal) cancer. We evaluated the effectiveness of surgical treatment between the 2 groups by measuring the rate of complete surgical resection, the postoperative complications, the postoperative mortality, tumor recurrence, the average life expectancy and the long-term survival. RESULT: On comparing both groups, there was no significant difference in the distribution of the pathological stage and no significant difference in the percentage of performing complete surgical resection. The percentage of postoperative complications was 39.1% (9 out of 23 patients) in the upper esophageal cancer group, and this was significantly higher than 16.9% (21 out of 124 patients) in the lower esophageal cancer group (p<0.05). However, there was no significant statistical difference between the groups for the percentages of postoperative mortality, tumor recurrence or the postoperative average life expectancy. CONCLUSION: There was no significant difference in operative mortality or surgical effectiveness between the 2 groups. Therefore, we thought that surgical treatment is also effective for treating upper esophageal cancer, but further investigation with large patient populations will be required.

Results of a Ivor-Lewis Operation for Esophageal Squamous Cell Carcinoma / 대한흉부외과학회지

BACKGROUND: The Ivor-Lewis operation has been widely applied for treating thoracic esophageal cancer, but more acceptable results from three-field lymph node dissection have recently been reported. In this study the efficacy of the Ivor-Lewis operation was evaluated. MATERIAL AND METHOD: Among the 273 patients, who underwent operation for esophageal cancer between September 1994 and August 2004, we retrospectively studied 172 patients with esophageal squamous cell carcinoma and who had no other primary cancer and who underwent complete resection with an Ivor-Lewis operation. The postoperative complications, the short and long-term survival and the recurrence patterns were analyzed. RESULT: The postoperative staging was as follows: stage I in 40 cases, IIA in 48 cases, IIB in 18 cases, III in 55 cases, IVA in 5 cases and IVB in 6 cases. The operative mortality rate was 4% (7 of 172 pts). Postoperative complication occurred in 32 patients (18%) and tumor recurred in 55 patients (32%). The overall 5-year survival rate was 48%; it was 85.6% in stage I patients, 47.6% in IIA patients, 65% in IIB patients, 22.8% in III patients and 0% for those in IV (p0.05). CONCLUSION: The Ivor-Lewis operation is an acceptable surgical procedure for thoracic esophageal squamous cell carcinoma. Yet it is necessary to consider other surgical procedures, and especially three-field lymph node dissection for treating upper 1/3 esophageal cancer.

Minimally Invasive Surgery for Esophageal Cancer / 대한소화기학회지

Minimally invasive surgery is now rapidly developing and becoming a standard surgical option in some fields. In the past, many thoracic surgeons were reluctant to adopt minimally invasive techniques in esophageal cancer surgery due to concern over the oncologic perspectives and technical difficulties. However, over the last few years, thoracic surgeons have progressively embraced the technical advancements and now many experienced centers have adopt minimally invasive surgery as a primary option for non-advanced esophageal cancer operations. In esophageal cancer surgery, the volume of operation performed in some hospital is closely related to the outcome of patients, and the experiences of surgical team play an important role in minimally invasive surgery. Minimally invasive esophageal surgery (MIES) has steep learning curves, also. The merits of MIES are as follows. The conventional esophageal cancer operation has two or triple incisions, resulting in high postoperative morbidity and mortality. However, postoperative complication in MIES became less frequent than conventional surgery. The patient's satisfaction is high. Mid-term outcomes of MIES have been reported that it is safe and feasible in esophageal cancer and survival curves are similar to those of conventional surgery. Therefore, MIES is a valuable therapeutic modality for both esophageal cancer patients and thoracic surgeons.

Anastomotic Leakage and Stricture Relating to Anastomotic Level and Methods in Esophageal Resection and Reconstruction for Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: The prevalence of anastomotic complication is related to anastomotic procedure or site in esophageal cancer operation. We studied the anastomotic leakage and stricture related to the anastomotic procedure &site in patients who received the esophageal resection and reconstruction for esophageal cancer. MATERIAL AND METHOD: The anastomotic procedure, site and complication of 321 patients who received the esophageal reconstruction from August 1993 to May 2003 were investigated. Mean age was 64.5+/-4.9 (37~94) years, 300 patients (93.5%) were male and 21 patients were female (6.5%). RESULT: There were 7 anastomotic leakages (2.2%) and no difference in anastomotic site (cervical anastomosis 4.1%, thoracic anastomosis 1.6%) and procedure (stapler technique 1.6%, semi-staple technique 9.1%, hand-sewn technique 0.0%). There were 52 anastomotic strictures (16.2%), differences in sites (cervical anastomosis 2.7%, thoracic anastomosis 20.2%) (p <0.001) and procedure (stapler technique 20.0%, semi-stapler technique 3.0%, hand-sewn technique 4.7%). And the stapler technique showed higher stricture rate (p <0.001). CONCLUSION: Anastomotic technique was less related to anastomotic leakage in esophageal reconstruction for esophageal cancer. However, stapler technique had higher stricture rate than other techniques. Therefore, we suggest that the anastomotic technique be improved to reduce anastomotic stricture.