Assessment of the surgical option esophagogastrectomy with and with out feeding jejunostomy in management of cancer lower two thirds oesophageus

ABSTRACT

The outcome of the surgical management of 39 consecutive patients with carcinoma of the distal two thirds of the oesophagus over a 5-years period is reviewed. Lewis Tanner oesophagectomy was performed for resectable cases. Patients were classified into two groups [A and B], according to the adopted method of pre and postoperative nutritional support. Primary surgery was carried out in 15 patients group A [parenteral nutrition] and in 24 patients group B [T-tube feeding jejunostomy]. Resectability rates of both groups were 80 and 83 percent respectively. Tumour staging was assessed intraoperative and compared with preoperative categorization. Three patients group A [20 percent], and 4 patients group B [17 percent] were found having irresecrable tumours during exploration [stage IV]. Hospital mortality rate was 25 percent, all belonged to group A cases. Incidence of late postoperative complications and survival data were recorded in both groups. Resection of the oesophageal tumours has led to effective palliation of the patient symptoms. Only 7 percent [2/12] of group A patients were living at [3-5 years], both initially had stage I disease and squamous cell tumours, while 35 percent [7/20] of group B patients were living at [3-34 months], all initially had stage I and II disease, 5 had squamous cell tumour and 2 had adenocarcinoma. It is clear that late presentation is a limiting factor in improving results. The value of T-tube feeding jejunostomy was predicted by reduction of early postoperative morbidity in group B cases