Esophagectomy in Esophageal Cancer - is there an Optimal Approach
N. Dănilă, C. Lupaşcu, M. Andronic, M. Costache, O. Dumitaş, A. Plesa, M. Blaj, O. ApopeiOriginal article, no. 5, 2014
Introduction: Esophageal cancer is a public health problem,with increasing incidence and postoperative morbidity overthe past recent years. Although a number of new surgicaltechniques, including minimally invasive surgery, have beendeveloped, mortality and morbidity have remained elevated.The element that seems to influence the early postoperativemorbidity and mortality is the method of approach.
Material and Methods: retrospective observational study whichis carried out in the period 2003-2012 including esophagealneoplasm patients operated in the First Surgical Clinic -Hospital "Sf. Spiridon", Iasi. 140 patients were included, ofwhich only 33 have received surgery with curative aim.
Surgical technique: we consider 2 techniques in our study:transhiatal (TH) technique (without opening the chest)followed by esophagoplasty with cervical anastomosis andtransthoracic esophagectomy (TT) with intrathoracic orcervical anastomosis.
Results: We performed 57.58 % (n = 19) of interventions by TT versus 42.42% (n = 14) by TH. The overall rate of postoperativemorbidity rate was 78.8% (n = 26). Overall earlypostoperative mortality rate was 15.5% (n = 5) caused bypleuropulmonary sepsis (2 cases), lung emboli (1 case) andsepsis caused by anastomotic leak (2 cases).Conclusion: TT and TH esophagectomy have precise indicationsin esophageal surgery for malignancies, the mortality andmorbidity rate being strongly influenced by the surgicalapproach.
Material and Methods: retrospective observational study whichis carried out in the period 2003-2012 including esophagealneoplasm patients operated in the First Surgical Clinic -Hospital "Sf. Spiridon", Iasi. 140 patients were included, ofwhich only 33 have received surgery with curative aim.
Surgical technique: we consider 2 techniques in our study:transhiatal (TH) technique (without opening the chest)followed by esophagoplasty with cervical anastomosis andtransthoracic esophagectomy (TT) with intrathoracic orcervical anastomosis.
Results: We performed 57.58 % (n = 19) of interventions by TT versus 42.42% (n = 14) by TH. The overall rate of postoperativemorbidity rate was 78.8% (n = 26). Overall earlypostoperative mortality rate was 15.5% (n = 5) caused bypleuropulmonary sepsis (2 cases), lung emboli (1 case) andsepsis caused by anastomotic leak (2 cases).Conclusion: TT and TH esophagectomy have precise indicationsin esophageal surgery for malignancies, the mortality andmorbidity rate being strongly influenced by the surgicalapproach.
