Esophagectomy for Cancer of the Esophagus- GMC Jammu Experience

We retrospectively reviewed a data of 202 patients, who underwent esophagectomy for cancer of the esophagusover 12 years at GMC, Jammu. Out of 262 patients, 202 patients underwent esophagectomy, mean age was53 years, ranging between 31-75 years. 160 patients had squamous cell carcinoma and 31 patients hadadenocarcinoma. 148 patients underwent transhiatal esophagectomy (Orringer’s procedure), whereas 18patients underwent McKeown’s three incision procedure and 10 patients underwent transthoracic esophagectomy(Ivor lewis) procedure. It was observed that mid third tumors accounted for 40%, lower third tumorsaccounted for 55 % and GE junction tumors 5% of the cases. Squamous cell carcinoma was the mostcommon histology (79.5 %). The overall morbidity (significant complications leading to prolonged hospitalization)was 38 %. Perioperative mortality was 13(6.43%). We hereby conclude that esophagectomy is a majorsurgical operation and gives palliation of dysphagia to patient and our experience with it has been with acceptablemorbidity and with favorable short-term results.

Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer

Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common.

Estenosis esofágica por ingestión de cáusticos / Esophageal stenosis due to caustic ingestion

RESUMEN Las sustancias químicas son causas importantes de lesiones del tracto gastrointestinal y suelen afectar dos grupos de pacientes: los niños menores de 5 años y los adultos que intentan el suicidio. La principal complicación de la ingesta accidental de cáusticos es la estenosis esofágica. Diferentes formas de tratamiento se han aplicado para tratar las estenosis esofágicas por cáusticos y en primera línea está la dilatación endoscópica, con resultados exitosos en el 60 a 80% de los pacientes. Si estas no son efectivas, se indica el tratamiento quirúrgico de reemplazo esofágico, y entre las técnicas más frecuentes destaca la esofagectomía de dos vías de Ivor Lewis y la esofagectomía transhiatal. Se presenta el caso de un paciente del sexo masculino de 20 años de edad que consultó en el Departamento de Cirugía por cuadro de dificultad para la deglución, con el antecedente de ingestión accidental de soda caústica 2 meses antes. Con estudios imagenológicos y endoscópicos se confirmó el diagnóstico de estenosis esofágica por ingestión de cáusticos. Se le realizó una esofagectomía transhiatal asociado a una yeyunostomía de alimentación. La complicación presentada fue neumotórax bilateral en post operatorio, el cualfue resuelto con tubo de drenaje pleural sellado bajo agua. Se indicó el alta hospitalaria en su 15 día de postoperatorio, con buena tolerancia oral.

ABSTRACT Chemicals are important causes of gastrointestinal tract lesions and usually involve two groups of patients: children under 5 years and adults who attempt suicide. The main complication of accidental ingestion is caustic esophageal stricture. Different forms of treatment have been used to treat esophageal stricture and on the frontline is the endoscopic dilation, with successful results in 60 to 80% of patients. If these are not effective, surgical treatment is indicated with esophageal replacement and the most common techniques are the two-way Ivor Lewis esophagectomy and transhiatal esophagectomy. We present a case of a male patient, aged 20 years, consulting in the Department of Surgery with difficulty to swallowing, with a history of accidental ingestion of caustic soda 2 months before. Imaging and endoscopic studies confirmed the diagnosis of esophageal stenosis of caustic ingestion. He underwent a transhiatal esophagectomy associated with a feeding jejunostomy. The complication was bilateral pneumothorax presented in the postoparative time, which was resolved with pleural drainage tube sealed under water. He was discharged from hospital in 15 days after surgery, with good oral tolerance.

Transhiatal Esophagectomy in Cardia and Esophageal Cancer

PURPOSE: The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy (THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries. MATERIALS AND METHODS: In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed. RESULTS: A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P0.05). CONCLUSION: For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus.

On the safety of video-assisted mediastinoscopic esophagectomy / 中国微创外科杂志

0 05) between the two procedures in incidence of anastomotic leakage (25 0% vs 10 7%), pulmonary infection rate (31 3% vs 32 1%), incide nce of thoracic cavity infection (0 vs 3 6%), proportion of re-thoracotomy (0 vs 3 6%), incidence of d elayed gastric emptying (3 1% vs 21 4%), postoperative SICU stay (4d?2 3d vs 5d ?3 6d), and peri-operative mortality (3 1% vs 7 1%). The incidence of recurr ent laryngeal nerve injuries (28 1% vs 7 1%, ? 2=4 391,P =0 036) and arr hythmia (43 8 % vs 17 9%, ? 2 =4 627, P =0 031) in the THE Group were significantly higher than those in the TTE Group, while the intra-operative blood loss in the THE Group was signif icantly less than that in the TTE Group ( t = -3 100, P =0 003).ConclusionsVideo- assisted THE is a safe procedure. With the increase of the experience, the incid ence of post- operative complications is subject to further decrease.

Reconstruction Using Stomach after Resection of Hypopharynx and Esophagus

PURPOSE: This study sought to evaluate the treatment modality, morbidity and mortality after surgery, the method of nutritional support and the survival rate for patients with cancer of the hypopharynx, larynx and cervical esophagus. METHODS: A retrospective review was undertaken of 17 hypopharyngeal, laryngeal and cervical esophageal carcinoma patients who had undergone surgical treatment in the Department of Surgery and Otorhinolaryngology, Yonsei University, College of Medicine, from January 1995 to April 2000. All patients underwent transhiatal esophagectomy in order to avoid pulmonary complications. Outcome measures were calculated using the Kaplan-Meier estimator. RESULTS: The 17 consecutive patients included 11 cases of hypopharyngeal cancer, 3 glottic cancers, 2 cervical esophageal cancers and one thyroid cancer with invasion of the trachea and esophagus. Fifteen patients (88%) presented with an advanced tumor stage. As for nutritional support following surgery, 12 underwent feeding jejunostomy, 4 a nasoenteric tube feeding and the other recieved total parenteral nutrition. Nine patients (53%) developed complications following surgery. One of the patients who had surgery died postoperatively. The mean survival time was 26 months and the 2-year and 4-year overall survival rates were 69.5% and 53.0%, respectively. CONCLUSION: Reconstruction of the hypopharynx and esophagus using stomach was low mortality and low severe morbidity. A total pharyngolaryngoesophagectomy with gastric transposition and primary hypopharyngogastric anastomosis offers the best chance for cure or palliation with acceptable morbidity and degree of function for selected patients with advanced hypopharyngeal, laryngeal and cervical esophageal carcinomas.

Transhiatal Esophagectomy Using Laparoscope in Esophageal Cancer / 대한암학회지

PURPOSE: To remove the tumor and to restore continuity is very important in patients with esophageal cancer for cure of disease or palliation. To compare the outcome of Transhiatal Esophagectomy using Laparoscope (Lapa-THE), author`s modification of traditional tanshiatal esophagectomy, with that of transhiatal esophagectomy (THE). MATERIALS AND METHODS: The author performed THE in 10 cases with esophageal cancer and Lapa-THE in 5 cases with esophageal cancer from March 1992 to August 1996 in Department of Surgery, Pusan National University Hospital. RESULTS: Of all 15 cases with esophageal cancer, 6 cases were occurred at 6th decade and 3 cases were occurred at 7th decade. The ratio of male to female was 4:1. The all 5 cases with Lapa-THE were mid-thoracic esophageal cancers. Of 10 cases with THE, the cancer occurred 2 cases in mid-thoracic esophagus, 4 cases in lower-thoracic esophagus and 4 cases in cardia portin. According to pathological type, the 12 cases were squamous cell carcinoma, 2 cases were adenocarcinoma, and 1 case was small cell carcinoma. Of all 10 cases with THE, the postoperative death was occurred in 1 case due to graft necrosis, other postoperative complications were occured in 5 cases, stenosis of anastomotic site in 3 cases, wound infection in 1 case and pleural effusion in 1case. In the cases with Lapa-THE, stenosis was occurred in 1 case, wound infection in 1 case and there was no postoperative death. CONCLUSION: The Lapa-THE is comparable therapeutic technique with conventional THE for treatment of patient with esophsgeal cancer, especially it was useful in mid-thoracic esophageal cancer.