EARLY RESULTS OF OESOPHAGECTOMY FOR CARCINOMA OESOPHAGUS IN 1008 CASES
AbstractObjective: 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
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