The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third

Lewis, Ivor

doi:10.1002/bjs.18003413304

Cited by 523 publications

(192 citation statements)

References 27 publications

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“…Los valores de p para la comparación entre grupos se calcularon aplicando la prueba de la t de Student. Para los valores no numéricos se utilizó el test de la 2 de Pearson. Los parámetros con distribución normal se presentan como media y desviación estándar.…”

Section: Materials Y Métodosunclassified

Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los márgenes de resección y ganglios linfáticos

et al. 2008

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ResumenIntroducción. El tratamiento quirúrgico de cáncer de esófago está asociado a alta morbilidad y mortalidad. La cirugía mínimamente invasiva se ha propuesto como una alternativa para intentar reducir estas complicaciones; sin embargo, no hay en la actualidad muchos estudios que valoren la validez oncológica de esta cirugía. El propósito de este trabajo es, de manera preliminar, auditar los resultados en nuestra experiencia de ambas técnicas quirúrgicas centrando la atención especialmente en los aspectos oncopatológicos (márgenes de resección y ganglios linfá-ticos).Material y método. Entre abril de 2003 y febrero de 2007, se intervino a 40 pacientes diagnosticados de cáncer de esófago distal en el Hospital Charing Cross de Londres, 24 por vía abierta y 16 por vía laparoscópica, de acuerdo con el cirujano responsable. El 50% de ellos recibieron tratamiento quimioterápico neoadyuvante. Ambos grupos fueron homogéneos para edad, sexo, ASA, estadio tumoral y localización tumoral. En todos los casos se recogió de modo prospectivo en una base de datos el estadio tumoral patológico (TNM), margen distal tumoral, margen proximal tumoral, margen circunferencial tumoral y nú-mero de ganglios linfáticos resecados.Resultados. El número de ganglios linfáticos resecados fue similar en ambos grupos (19 para la vía abierta y 18 para la laparoscópica). El margen distal tumoral medio para el grupo tratado por vía abierta fue de 4,9 cm frente a 4,3 en el grupo tratado con laparoscopia (p = 0,578). El margen proximal tumoral medio para el grupo tratado por vía abierta fue de 8,4 cm frente a 4,6 cm en el grupo por laparoscopia (p = 0,004) y el margen circunferencial tumoral fue positivo en 11 (45%) pacientes del grupo de vía abierta frente a 5 (33%) pacientes del grupo laparoscópico (p = 0,519).Conclusiones. La cirugía laparoscópica para el cáncer de esófago, en nuestra experiencia, parece mostrar resultados iniciales similares a los ofrecidos por vía abierta en cuanto a número de ganglios linfá-ticos resecados y márgenes de resección.Palabras clave: Cáncer de esófago. Cirugía mínimamen-te invasiva. Esofagectomía transhiatal.

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Section: Materials Y Métodosunclassified

Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los márgenes de resección y ganglios linfáticos

et al. 2008

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“…Despite this initial success only 2 of the subsequent 25 patients survived the postoperative period (2). Fortunately, in the following century the desperately needed technical innovation resulted in acceptable postoperative survival and quality of life (3)(4)(5)(6)(7)(8)(9). The most recent development was the minimally invasive transthoracic esophagectomy (8).…”

Section: Introductionmentioning

confidence: 99%

New insights into the surgical anatomy of the esophagus

Weijs¹,

Ruurda²,

Luyer³

et al. 2017

J. Thorac. Dis.

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Implementation of (robot assisted) minimally invasive esophagectomy and increased knowledge of the relation between the autonomic nervous system and the immune response have led to new insights regarding the surgical anatomy of the esophagus. First, two layers of connective tissue were identified; the aorto-esophageal and aorto-pleural ligaments that separate the peri-esophageal compartment, containing vagus nerves, carinal lymph nodes and trachea, from the para-aortic compartment; containing thoracic duct and azygos vein. Second the surgical anatomy of the pulmonary vagus nerve branches has been described in detail. Based on the hypothesis that sparing the vagal nerve branches may be important a method to spare the pulmonary branches of the vagus nerve during thoracoscopic esophagectomy was validated in a cadaver study. Further studies will now investigate the impact of these new insights in the surgical anatomy of the esophagus in clinical practice.

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“…Staple with a circular stapler (CS) is regarded as a safe alternative to manual suturing in colonic, rectal [4], and gastric anastomosis [5], as well as esophagogastric anastomosis [6]. With the development of surgical techniques, many advances have been applied to the surgery of esophageal cancer in the past decade [7,8]. Although lower rate of mortality has always been reported [9][10][11], the postoperative complications are proven to be frequently common, which included anastomotic leakage and stricture.…”

Section: Introductionmentioning

confidence: 99%

Hand-Sewn Versus Stapled Esophagogastric Anastomosis in the Neck: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Wang

Shi

et al. 2013

Indian J Surg

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The application of cervical esophagogastric anastomoses was of great concern. However, between circular stapler (CS) and hand-sewn (HS) methods with anastomosis in the neck, which one has better postoperative effects still puzzles surgeons. This study aims to systematically evaluate the effectiveness, security, practicality, and applicability of CS compared with the HS method for the esophagogastric anastomosis after esophageal resection. A systematic literature search, as well as other additional resources, was performed which was completed in January 2013. The relevant randomized controlled trials (RCTs) about the surgical technique for esophageal resection were included. Trial data was reviewed and extracted independently by two reviewers. The quality of the included studies was assessed by the recommended standards basing on Cochrane handbook 5.1.0, and the data was analyzed via RevMan 5 software (version 5.2.0). Nine studies with 870 patients were included. The results showed that in comparing HS to CS methods with cervical anastomosis, no significant differences were found in the risk of developing anastomotic leakages (relative risk (RR)=1.30, 95 % confidence intervals (CI) 0.87-1.92, p =0.20), as well as the anastomosis stricture (RR=0.97, 95 % CI 0.47-1.99, p =0.93), postoperative mortality (RR = 0.83, 95 % CI 0.43-1.58, p =0.57), blood loss (mean difference (MD)=39.68; 95 % CI −6.97, 86.33; p =0.10) and operative time (MD=18.05; 95 % CI −3.22, 39.33; p =0.10). However, the results also illustrated that the CS methods with cervical anastomosis might be less time-consuming and have shorter hospital stay and higher costs. Based upon this meta-analysis, there were no differences in the postoperative outcomes between HS and CS techniques. And the ideal technique of cervical esophagogastric anastomosis following esophagectomy remains under controversy.

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The surgical treatment of carcinoma of the oesophagus with special reference to a new operation for growths of the middle third

Cited by 523 publications

References 27 publications

Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los márgenes de resección y ganglios linfáticos

Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los márgenes de resección y ganglios linfáticos

New insights into the surgical anatomy of the esophagus

Hand-Sewn Versus Stapled Esophagogastric Anastomosis in the Neck: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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