Treatment of dysphagia in esophageal carcinoma: Transthoracic En-Bloc esophagectomy and reconstruction 48 hours later |
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Authors: | J R Siewert MD A H Hölscher MD |
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Institution: | 1. Department of Surgery, Technische Universit?t München, Ismaninger Stra?e 22, 8000, Munich 80, West Germany
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Abstract: | In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc”
esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with
delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group
of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy
and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary
features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different
between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure
are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After
2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval
of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc
esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure.
It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome. |
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Keywords: | Esophageal cancer Transthoracic esophagectomy Mediastinal lymphadenectomy Delayed reconstruction Blunt esophageal dissection |
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