Analysis of results of surgery performed over a 20-year period on 500 patients with cancer of the thoracic esophagus

Abstract

This study was conducted to examine the long-term outcome of 500 patients who underwent surgery for cancer of the thoracic esophagus during the past 20 years. Favorable results were obtained with postoperative adjuvant radiation and chemotherapy and there were no surgical deaths in the last 5 years. The mortality rate decreased from 17% prior to 1980 to 5% between 1981 and 1993, this being most probably attributable to the decreased incidence of suture leakage. With respect to changes in surgical techniques, during the initial years we performed intrathoracic anastomosis, after which sternal manubrium resection with anterior mediastinal esophagogastrostomy was carried out. Subsequently, we invented a technique for performing esophagogastrostomy via the posterior mediastinum. The posterior mediastinum was selected as the most physiologic route, based on measurement of tissue oxygen tension. Using blood flow determinations obtained by laser-Doppler velocimetry, we concluded that the effectiveness of thicker gastric tubes was superior to that of thin tubes. Esophagogastrostomy was performed in a shallow field in the cervical region, with the anastomosis ultimately positioned in the superior mediastinum and covered with mediastinal pleura.

Extravascular Lung Water Measured Using Single Transpulmonary Thermodilution Reflects Perioperative Pulmonary Edema Induced by Esophagectomy

“…Our standard operative procedure is right transthoracic esophagectomy and resection of the lesser curvature with dissection of the mediastinal (involving the periesophageal region and areas around trachea and bilateral main bronchus) and the abdominal (involving the perigastric region and areas around the celiac axis) lymph nodes [1,10,11] . For upper thoracic esophageal cancer, or when metastases involve neck and/or upper mediastinal lymph nodes, we add bilateral neck dissection and perform a so-called three-field lymph node dissection.…”

“…Esophagectomy with extensive lymph node dissection for thoracic esophageal cancer is one of the most invasive surgical procedures and continues to be associated with high a morbidity, despite improvements in the surgical techniques [1,2] . It is associated, for instance, with severe hemodynamic changes involving loss of circulating blood volume and filling of the third space during the immediate postoperative period.…”

The measurement and monitoring of surgical adverse events

“…Different methods have been used to predict anastomotic leak, including the measurement of haemostatic markers, 225,309 the assessment of the blood supply and tissue oxygen tension (PtO 2 ) perioperatively 225,231,[309][310][311] and the quantification of various factors in drainage secretions.…”

“…Abo and co-workers 310 implanted sensors at the anastomotic site in patients undergoing reconstructive surgery of thoracic oesophageal cancer to measure blood and PtO 2 levels, and found that oxygen levels varied significantly in the presence of suture leakage. Schilling and co-workers 231 conducted a similar uncontrolled, observation study to measure gastric perfusion before, during and after gastric tube formation in patients undergoing thoracic oesophagectomy.…”

Preventive Wrapping of the Fragile Tracheobronchial Wall Using a Flap of Latissimus Dorsi Muscle during Esophagectomy after Chemoradiotherapy

“…The posterolateral thoracotomy incision is then closed. Thereafter, with the patient in a supine position, esophageal reconstruction is done using gastric tube or colon tissue via the subcutaneous or retrosternal route [3,4] .…”