EARLY RESULTS OF OESOPHAGECTOMY FOR CARCINOMA OESOPHAGUS IN 1008 CASES

Authors

  • Bilal A Bilal
  • Baseer A Baseer
  • Ahmad M Ahmad
  • Imran M Imran
  • Abid M Abid
  • Kalimullah M Kalimullah

Abstract

Objective: To determine the early results of 1008 oesophagectomies done for carcinoma oesophagusover a 9 years period. Methods: This observational descriptive study was conducted at Department ofCardiothoracic Surgery, Lady Reading Hospital, and Khyber Medical Centre Peshawar from June 2002to June 2011. All patients had apart from routine investigations, Barium studies, Endoscopy and biopsy,CT thorax/upper abdomen with oral and I/V contrast and abdominal ultrasound. The operativeapproaches included left thoracolaparotomy with left neck anastomosis, transhiatal, leftthoracolaparotomy with Roux en-Y, McKeown with right decortication, Ivor Lewis and leftthoracolaparotomy with left decortication. All operations were done by one surgical team. The hospitalrecords and operation reports of these patients were carefully analysed for demographic feature;operative approach and outcome. Results: Out of 1008 cases, 698 were males and 310 were femaleswith a mean age of 51.6 years. The age range was 17–80 years. Out of 1008 cases 611 (60.61%) caseshad lower one third tumours, 384 (38.09%) cases had middle one third tumours while 13 (1.28%)tumours were just below the thoracic inlet. Of the 611 lower ⅓ tumours stomach involvement waspresent in 271 (44.35%) cases. Adenocarcinoma was present in 516 (51.19%) cases, squamous cellcarcinoma was present in 485 (48.11%), adenosquamous was 6 (0.59%) and carcinoma in situ waspresent in 1 case (0.09%). Morbidity was 63/1008 (6.25%), and comprised anastomotic leaks 15,aspiration pneumonia 13, wound infection 13, hoarseness 8, and strictures 14, 30-day mortality was23/1008 (2.28%) and causes included aspiration pneumonia-respiratory failure (5), myocardialinfarction (4), anastomotic leak (6), tracheal injury (2), and presumed pulmonary embolism (6).Conclusion: More than 1000 cases in 9 years is a very high oesophageal workload for malignancy.Morbidity of 6.25% and mortality of 2.28% shows that such major operations can be done safely inthoracic centres.Keywords: oesophagectomy, carcinoma oesophagus, outcome

References

Kuo EY, Chang Y, Wright CD.. Impact of hospital volume on

clinical and economic outcomes for esophagectomy. Ann Thorac

Surg 2001;72:1118–24.

Dimick JB, Cowan JA Jr, Ailawadi G, Wainess RM, Upchurch

GR Jr. National Vraiation In oprative Mortality Rates for

Esophageal Resection and Need for Quality improvement. Arch

Surg 2003;138:1305–9.

Shahian DM, Normand SLT. The Volmune-outcome

relationship: from left to leapfrog .Anna Thoracic Surg

;75:1048–58.

Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA. Dimick JB,

Pronovost PJ, Cowan JA, Lipsett PA. Surgical Volume and

quality care for esophageal resection: do high-volume hospitals

has fewer complications? Ann Thoracic Surg 2003;75:337–41.

Iqbal R, Mumtaz MS, Umar M, , Khaar HB, Anwar F, Mazhar S,

et al. Clinical spectrum of patients with esophageal, gastric and

clonic carcinomas in Rawalpindi Islamabad region. J Rawal Med

Coll 2001;5:53–5.

Aldserson D (Ed). The ooesophagus. In: Williams NS, Bulstrode

CJK, O Connel PR. Short practice of Surgery. 4th edition.

London: Edward Arnold; 2008. p. 1026.

Turkyilmaz A, Eroglu A, Aydin Y, Tekinbas C, Muharrem Erol

M, Karaoglanoglu N. The management of esophagogastric

anastamotic leak after esophagectomy for oesophageal

carcinoma. Dls Oesophagus 2009;22:119–26.

Mitchell JD. Anastamotic leakafter oesophagectomy. Thoracic

surg Clin 2006:16:1–9.

Figueroa JD, Terry MB, Gammon MD, Vaughan TL, Risch HA,

Zhang FF, Cigarette smoking, body mass index, gastroesophageal reflux disease, and non-steroidal anti-inflammatory

drug use and risk of subtypes of esophageal and gastric cancers

by P53 overexpression. Cancer Causes Control. 2009;20:361–8.

Alan H. The ooesophagus. In: A Adam, A K Dixon eds.

Diagnostic Radiology 5th ed. Philadelphia: Churchill Livingston;

p. 609–26.

Di Martino N, Izzo G, Cosenza A, Cerullo G, Torelli F, Monaco

L et al. Surgical therapy of adenocarcinoma of the

esophagogastric junction: analysis of prognostic factors.

Hepatogastroenterol 2005;52:1110–5.

Nabi MS, Bilal A, Shah SA Ahmad Z. Use of a feeding

jejunostomy after Esophageal Surgery.J Postgrad Med Ins

;15(1):43–5.

Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer

EJ, et al. SEER Cancer Statistics Review, 1975-2003, National

Cancer Institute. Bethesda MD. Available at:

http://seer.cancer.gov/csr/1975_2003/.

Barreto JC, Posner MC. Transhiatal versus transthoracic

esophagectomy for esophageal cancer. World J Gastroenterol

;16:3804–10.

Begg C B, Cramer L D, Hoskins W J, Brennan M F. Impact of

hospital volume on operative mortality for major cancer surgery.

JAMA 1998;280:1747–51.

Dimick JB, Cattaneo SM, Lipsett PA, Pronovost PJ, Heitmiller

RF. Hospital volume is related to clinical and economic

outcomes of esophageal resection in Maryland. Ann Thorac Surg

;72:334–41.

Van Lanschot JB, Hulscher JBF, Buskens CJ, Tilanus HW, ten

Kate FJ, Obertop H. Hospital volume hospital mortality for

esophagectomy. Cancer 2001;91:1574–8.

Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL,

Batista I, et al. Hospital volume and surgical mortality in the

United States. N Engl J Med 2002;346:1128–37.

Metzger R, Bollschweiler E, Vallböhmer D, Maish M,

DeMeester TR, Hölscher1 AH. High volume centers for

J Ayub Med Coll Abbottabad 2010;22(4)

http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Bilal.pdf

esophagectomy: what is the number needed to achieve low

postoperative mortality? Dis Oesophagus 2004;17:310–4.

Gilani JA, Hameed K, Asghar AH, Begum N, Jawad S. Outcome

of chemoreduction in treating carcinoma oesophagus. J Coll

Physicians Surg Pak 2003;13(10):562–4.

Gondal KM, Akhtar S, Choudary MA, Ijaz MJ, Shah T.

Transhiatal Esophagectomy A safe surgical outcome. Ann King

Edward Med Coll 2003;9(2):141–4.

Wouters MW, Wijnhoven BP, Karim-Kos HE, Blaauwgeers HG,

Stassen LP, Steup WH, et al. High-Volume versus Low-Volume

for Esophageal Resections for Cancer: The Essential Role of

Case-Mix Adjustments based on Clinical Data. Ann Surg Oncol

;15:80–87.

Qayum A, Khan JA, Shafir-ur-Rehman, Saleem SM, Qazi MA,

Mukhtar Mehboob M, et al. Results of Esophageal Carcinoma

Management-An experience of ten years 1988-1998, Pak J

Otolaryngol 2002;18(3):43–5.

Abbas A, Ali N, Hameed S, Shah MA. Resectability rates in

locally advanced Esophageal Carcinoma following neoadjuvant

chemo-radiotherapy. J Ayub Med Coll Abbottabad

;15(4):13–6.

Nabi MS, Bilal A, Shah SA, Ahmad Z, Khan MU, Farooq K, et

al. Gastric pull up reconstruction for laryngopharyngoesophagectomy. Ann King Edward Med Coll 2003;9(2):108–10.

Mehmood T, Abdul Arshad AR, Bashir S. Role of Transhiatal

Esophagectomy in Carcinoma of Oesophagus. Ann King Edward

Med Coll 1999;5(3,4):250–1.

Jamal S, Ahmad M, Khan AH. Carcinoma Oesophagus- A

clinicopathological study of 50 cases at Armed Force Institute of

Pathology Rawalpindi. Pak J Pathol 1997;8:24–8.

Ribert M Debrueres B, Lecomte-Houch M. Resection for

advanced cancer of thoracic oesophagus:cervical or thoracic

anastomosis? J Thorac Cardiovasc Surg 1992;103:784–9.

Tsutsui S, Moriguchi S, Morita M, Kuwano H, Matsuda H, Mori

M, et al, Multivariate analysis of postoperative complications

after esophageal resection. Ann Thoracic Surg 1992;53:1052–6.

van Andel JG, Dees J, Dijkhuis CM, Fokkens W, van Houten H,

de Jong PC, et al. Carcinoma of the oesophagus of treatment.

Ann Surg 1979;190:684–9.

Vigneswaran WT, Trastek VF, Pairolero PC, Deschamps C, Daly

RC, Allen MS, et al. Extended esophagectomy in the

maanagment of carcinoma of the upper thoracic oesophagus. J

Thorac Cardiovasc Surg 1994;107:901–7.

Wolfe WG, Vaughn AL, Seigler HF, Hathorn JW, Leopold KA,

Duhaylongsod FG. Survival of patients with carcinoma of the

esophagus treated with combined – modality therapy. J Thorac

Cardiovasc Surg 1993;105:749–55.

Wong J. Esophageal resection for cancer: the rationale of current

practice. Amr J Surg 1987;153:18–24.

Chasseray VM, Kiroff GK, Buard JL, Launois B. Cervical or

thoracic anastomosis for esophagectomy for carcinoma. Surg

Gynecol Obstet 1989;169:55–62.

Mathisen DJ, Grillo HC, Wilkins EW Jr, Moncure AC,

Hilgenberg AD.. transthoracic esophagectomy a safe approach

for carcinoma of the oesophagus. Ann Thoracic Surg

;45:137–43.

Tabira Y, Tabira Y, Okuma T, Kondo K, Kitamura N.

Indications for three field dissection followed by esophagectomy

for advanced carcinoma of the thoracic oesophagus. J Thorac

Cardiovasc Surg 1999;117: 239–45.

Afridi SP, Khan A, Waheed I. High Risk Factors in Patient with

Carcinoma Oesophagus. J Coll Physicians Surg Pak Oct

;10:368–70.

Orringer MB, Marshall B, Chang AC, Lee J, Pickens A, Lau CL.

Two thousand transhiatal esophagectomies changing trends,

lessons learned. Ann Surg 2007;246:363–74.

Cooke DT, Lin GC, Lau CL, Zhang L, Si MS, Lee J, et al.

Analysis of cervical esophagogastric anastomotic leaks after

transhiatal esophagectomy: Risk factors, presentation, and

detection. Ann Thorac Surg 2009;88:177–85.

Schuchert MJ, Abbas G, Nason KS, Pennathur A, Awais O,

Santana M, et al. Impact of anastomotic leak on outcomes after

transhiatal esophagectomy. Surg 2010;148:831–40.

Davies AR, Forshaw MJ, Khan AA, Noorani AS, Patel VM,

Strauss DC, et al. Transhiatal esophagectomy in a high volume

institution. World J Surg Oncol 2008;6:88.

Aslam V, Bilal A, Khan A, Bilal M, Zainulabideen, Ahmed M.

Gastroesophageal anastomosis: single-layer versus double-layer

technique-An experience on 50 cases. J Ayub Med Coll

;20(3):6–9.

Hsu HH, Chen JS, Huang PM, Lee JM, Lee YC. Comparison of

manual and mechanical cervical esophagogastric anastomosis

after esophageal resection for squamous cell carcinoma: a

prospective randomized controlled trial. Eur J Cardiothorac Surg

;25:1097–1101.

Fox M, Ah-Chong AK, Cheng SWK, Wong J. Comparison of a

single layer continuous hand-sewn method and circular stapling

in 580 esophageal anastomoses. Br J Surg 1991;78:342–5.

Published

2010-12-01