Oesophagectomy for carcinoma esophagus- Peshawar experience of 270 cases in 4 years

ABSTRACT

To audit the results of 270 Oesophagectomies done for Carcinoma Oesophagus over a 4 year period. This observational descriptive study was conducted at Department of Cardiothoracic Surgery, Lady Reading Hospital and Khyber Medical Centre Peshawar from Sep 2002 to Sep 2006. Computerized clinical data of 270 cases of Oesophagectomy for Carcinoma Oesophagus was retrospectively analyzed. All patients had apart from routine investigations, Barium studies, Endoscopy and biopsy, CT Thorax/Upper abdomen with Oral and I/V Contrast and Abdominal ultrasound. Detailed examination of clinical record was made to determine the surgical outcome. Out of 270 cases 189 were Males 81 were Females with a mean age of 51.6 years. The age range was 17-80 years. In out of two hundred and seventy cases one hundred and sixty two [162/270] [60%] cases had lower one third tumors, one hundred and five [105/ 270] [38.88%] cases had middle one third tumors while three [3/270] [1.11%] tumors were just below the thoracic inlet. Of the one hundred and sixty two lower one third tumors stomach involvement was present in eighty one [81/162] [30%] cases. Adenocarcinoma was present in one hundred and seventeen [117/270] [43.33%] cases, Squamous cell carcinoma was present in one hundred and forty four [144/270] [53.33%], Adenosquamous was six [6/270] [2.22%], Carcinoma in situ was two [2/270] [0.74%] and Leiomyoma was one [1/270] [0.370%]. Morbidity was 28/270 [10.370%] and comprised anastomotic leaks 09, aspiration pneumonia 06, wound infection 03, hoarseness 03, and strictures 03,. Thirty day mortality was 14/270 [5.185%] and included aspiration pneumonia-respiratory failure 02, myocardial infarction 03, anastomotic leak 03, tracheal injury 02 and presumed pulmonary embolism 04. Two hundred and seventy cases in four years is a very high volume of Oesophageal work load for malignancy. Our morbidity of 10.370% and mortality of 5.18% shows that such major operations can be done safely in thoracic centers