[Analysis of factors influencing the results of surgical treatment of esophageal cancer based on personal material]. / Analiza czynników wplywajacych na wyniki operacyjnego leczenia raka prezelyku w materiale wlasnym.

The aim of the study was to evaluate some factors which could influence postoperative course as well as early and late results of surgical treatment of thoracic esophageal cancer. 75 out of 90 patients treated surgically in the Department of General and Transplantation Surgery, Pomeranian Medical Academy, Szczecin were involved in the investigation. Basic laboratory tests, X-ray examination, endoscopy, tissue diagnosis, pulmonary ventilation study (since 1991) and ECG were done in all of them. The analyzed group of patients consisted of 71 males and 4 females. The period of follow-up ranged from 6 months to 10 years. The mean age of patients was 56.1 years and duration of dysphagia 4.62 months. The patients of stage II disease predominated and those in stage I comprised 12%. The weight loss was 8.89 kilograms and length of lesion 6.53 centimeters on average. Squamous cell carcinoma group was the largest and consisted of 63 patients, 7 of them had preoperative radiation therapy, 54 patients were operated on by right transthoracic approach following previous laparotomy. Esophagectomy was done by the method of Orringer, Akiyama and through the left transthoracic approach (following laparotomy) in 8, 2 and 3 patients respectively. In 8 patients esophagectomy was performed by the left transthoracic approach only. The operation was considered radical in 42 percent of patients. The most frequent tumor location was the mid esophagus appearing in 44 patients; 28 patients underwent chemotherapy postoperatively. Postoperative complications were found in 88 percent of patients. All the patients were divided into groups depending on the analyzed factor. The following factors have been investigated: age of patients, duration of dysphagia, stage of disease with a separate evaluation of T and N factors, weight loss, length of lesion, tissue diagnosis, preoperative radiation therapy, way of resection, tumor location, postoperative chemotherapy, effect of department and operating surgeon, complications postoperatively. It was found that both early and late results depended significantly on stage of disease including "T" and "N" factors (Tab. 2, 3, 4), tissue diagnosis (Tab. 5), type of resection (Tab. 6), location of tumor (Tab. 8), postoperative chemotherapy (Tab. 9) and experience of the department. Stage of disease together with method of operation have significantly influenced the incidence of cardiovascular complications encountered (Tab. 1, 2). Some topics of importance connected with the presented factors were dealt with in discussion, and studies available in literature regarding the outcome of modern directions concerning the treatment of esophageal cancer were also presented.

[Complications after esophageal resection due to cancer]. / Powiklania po resekcji przelyku z powodu raka.

The aim of the study was to evaluate complications searching for ways of decreasing their incidence. 225 patients with the diagnosis of thoracic esophageal cancer had been treated in the Department of General and Transplantation Surgery, Medicala Academy, Szczecin, within the period of 1984-1995, esophageal resection was done in 90 of them and 75 were submitted to the analysis. The majority of patients i.e. 65 of them had esophagogastric anastomosis performed within the thorax while in 10 patients the anastomosis was accomplished in the neck. Complications concerning cardiovascular and respiratory system wound healing, anastomotic leakage and gastric blood supply have been analysed. Cardiovascular and respiratory complications occurred in 24 and 66 per cent of patients with mortality rate of 28.6 and 12 per cent, respectively. Wound healing disturbances were found in 3.7 per cent of patients. Anastomotic fistulas and necrosis of the stomach were observed in 4 and 5.3 per cent of patients with mortality rate of 75 and 100 per cent, respectively. A statistically significant correlation between the incidence of cardiovascular complications and disease stage was found. Only in patients operated on in I and II disease stage can we expect the serious complications to be less frequent.