Selective Curative Approaches for Thoracic Esophageal Cancer
Keywords:
Esophageal carcinoma, three-phase esophagectomy, Ivor Lewis operationAbstract
Objective: To determine the survival probability of patients with carcinoma of the esophagus whounderwent en bloc esophagectomy and to compare two en-bloc surgical approaches.
Materials and Methods: Between October 2005 and September 2008, 81 patients with the diagnosis of
esophageal carcinoma were treated at Suratthani Hospital. Esophagectomy was performed on 64 (79%) of these
patients, 18 of whom had upper or mid esophageal carcinoma and underwent three-phase esophagectomy, while
46 had low esophageal carcinoma and underwent the Ivor Lewis operation. We analyzed the location and
histology of the tumor, the number and level of lymph nodes, operative morbidity and mortality, and their
influence on survival probabilities.
Result: The overall survival probability at 5 years was 19 %. The 5-year survival probabilities for the
three-phase esophagectomy (upper and mid esophageal cancer) and the Ivor Lewis operation (low esophageal
cancer) were 4 % and 25%, respectively, which were significantly different. There was no left cervical lymph
node metastasis in patients who underwent the Ivor Lewis operation. The most common complication was
wound infection. Most patients died from sepsis or myocardial infarction. The overall operative (hospital)
mortality rate was 8 %.
Conclusion: Location of the tumor should strongly influence the type of surgery performed for
esophageal carcinoma, and seemed to significantly affect the survival probabilities in the present study.
References
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for carcinoma of the esophagus and cardia: a comparison
and results after standard resection in three consecutive
eight-year intervals with staging criteria. J Thorac Cardiovasc
Surg 1997;113:836-46.
2. Orringer MB, Marshall B, Iannettoni MD. Transhiatal
esophagectomy: clinical experience and refinements. Ann
Surg 1999;230:392-403.
3. Putnam JB, Suell DM, McMurtrey MJ, et al. Comparison of
three techniques of esophagectomy within a residency
training program. Ann Thoracic Surg 1994;57:319-25.
4. Lieberman MD, Shriver CD, Bleckner S, et al. Carcinoma of
the esophagus. Prognostic significance of histologic type. J
Thorac Cardiovasc Surg 1995;109:130-8.
5. Gertsch P, Vauthey JN , Lustenberger AA, et al. Long-term
results of transhiatal esophagectomy for esophageal
carcinoma. A multivariate analysis of prognostic factors.
Cancer 1993;72:2312-9.
6. Vigneswarren WT, Trastek VF, Pairolero PC, et al. Transhiatal
and transthoracic resection for lower-third esophageal
carcinoma. Am J Surg 1997;174:320-4.
7. Gelfand GA, Finley RJ, Nelems B, et al. Transhiatal
esophagectomy for carcinoma of the esophagus and
cardia. Arch Surg 1992;127:164-7.
8. Karl RC, Schreiber R, Boulware D, et al. Factors affecting
morbidity, mortality, and survival in patients undergoing
Ivor-Lewis esophagogastrectomy. Ann Surg 2000;231:635-
643.
9. Golminc M, Maddern G, Le Prise E, et al. Oesophagectomy
by a transhiatal approach or thoracotomy : a prospective
randomized trial. Br J Surg 1993;80-367-70.
10. Skinner DB, Ferguson MK, Soriano A, et al. Selection of
operation for esophageal cancer based on staging. Ann
Surg 1986;204:391-401.
11. Orringer MB, Sloan H. Esophagectomy without thoracotomy.
J Thorac Cardiovasc Surg 1987;76:643-654.
12. Skinner DB. En bloc resection for neoplasms of the esophagus
and cardia. J Thorac Cardiovasc Surg 1983;85:59-71.
13. Orringer MB, Forastiere AA, Perez -Tamayo C, et al.
Chemotherapy and radiation therapy before transhiatal
esophagectomy for esophageal carcinoma. Ann Thorac
Surg 1990;49:348-355.
14. Isono K, Sato H, Nakayama K. Results of a nationwide study
on the three fields o lymph node dissection in esophageal
cancer. Oncology 1991;48:411.
15. American Joint Committee on Cancer. AJCC Cancer
Staging Handbook. Philadelphia: Lippincott-Raven;1998:67.
16. Kato H , Watanabe H, Tachimori Y, et al. Evaluation of neck
lymph node dissection for thoracic esophageal carcinoma.
Ann Thorac Surg 1991;51:931-5.
17. Akiyama H, Tasurumaru M, Udagawa Y, et al. Systematic
Lymph node dissection for cancer: effective or not? Dis
Esoph 1994;7:1-12.
18. Baba M, Aikou T, Yoshinaka H, et al. Long-trem result of
subtotal esophagectomy with three-field lymphadenectomy
for carcinoma of the thoracic esophagus. Ann Surg
1994;219:310-6.
19. Pera M, Cameron AJ, Trastek VF, et al. Increasing incidence
of adenocarcinoma of the esophagus and esophagogastric
junction. Gastroenterology 1993;104:510-3.
20. Visbal AL, Allen MS, Miller DL, et al. Ivor Lewis
esophagogastrectomy for esophageal cancer. Ann
Thorac Surg 2001;71:1803-8.
for carcinoma of the esophagus and cardia: a comparison
and results after standard resection in three consecutive
eight-year intervals with staging criteria. J Thorac Cardiovasc
Surg 1997;113:836-46.
2. Orringer MB, Marshall B, Iannettoni MD. Transhiatal
esophagectomy: clinical experience and refinements. Ann
Surg 1999;230:392-403.
3. Putnam JB, Suell DM, McMurtrey MJ, et al. Comparison of
three techniques of esophagectomy within a residency
training program. Ann Thoracic Surg 1994;57:319-25.
4. Lieberman MD, Shriver CD, Bleckner S, et al. Carcinoma of
the esophagus. Prognostic significance of histologic type. J
Thorac Cardiovasc Surg 1995;109:130-8.
5. Gertsch P, Vauthey JN , Lustenberger AA, et al. Long-term
results of transhiatal esophagectomy for esophageal
carcinoma. A multivariate analysis of prognostic factors.
Cancer 1993;72:2312-9.
6. Vigneswarren WT, Trastek VF, Pairolero PC, et al. Transhiatal
and transthoracic resection for lower-third esophageal
carcinoma. Am J Surg 1997;174:320-4.
7. Gelfand GA, Finley RJ, Nelems B, et al. Transhiatal
esophagectomy for carcinoma of the esophagus and
cardia. Arch Surg 1992;127:164-7.
8. Karl RC, Schreiber R, Boulware D, et al. Factors affecting
morbidity, mortality, and survival in patients undergoing
Ivor-Lewis esophagogastrectomy. Ann Surg 2000;231:635-
643.
9. Golminc M, Maddern G, Le Prise E, et al. Oesophagectomy
by a transhiatal approach or thoracotomy : a prospective
randomized trial. Br J Surg 1993;80-367-70.
10. Skinner DB, Ferguson MK, Soriano A, et al. Selection of
operation for esophageal cancer based on staging. Ann
Surg 1986;204:391-401.
11. Orringer MB, Sloan H. Esophagectomy without thoracotomy.
J Thorac Cardiovasc Surg 1987;76:643-654.
12. Skinner DB. En bloc resection for neoplasms of the esophagus
and cardia. J Thorac Cardiovasc Surg 1983;85:59-71.
13. Orringer MB, Forastiere AA, Perez -Tamayo C, et al.
Chemotherapy and radiation therapy before transhiatal
esophagectomy for esophageal carcinoma. Ann Thorac
Surg 1990;49:348-355.
14. Isono K, Sato H, Nakayama K. Results of a nationwide study
on the three fields o lymph node dissection in esophageal
cancer. Oncology 1991;48:411.
15. American Joint Committee on Cancer. AJCC Cancer
Staging Handbook. Philadelphia: Lippincott-Raven;1998:67.
16. Kato H , Watanabe H, Tachimori Y, et al. Evaluation of neck
lymph node dissection for thoracic esophageal carcinoma.
Ann Thorac Surg 1991;51:931-5.
17. Akiyama H, Tasurumaru M, Udagawa Y, et al. Systematic
Lymph node dissection for cancer: effective or not? Dis
Esoph 1994;7:1-12.
18. Baba M, Aikou T, Yoshinaka H, et al. Long-trem result of
subtotal esophagectomy with three-field lymphadenectomy
for carcinoma of the thoracic esophagus. Ann Surg
1994;219:310-6.
19. Pera M, Cameron AJ, Trastek VF, et al. Increasing incidence
of adenocarcinoma of the esophagus and esophagogastric
junction. Gastroenterology 1993;104:510-3.
20. Visbal AL, Allen MS, Miller DL, et al. Ivor Lewis
esophagogastrectomy for esophageal cancer. Ann
Thorac Surg 2001;71:1803-8.
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Published
2013-06-28
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Luechakiettisak P. Selective Curative Approaches for Thoracic Esophageal Cancer. Thai J Surg [Internet]. 2013 Jun. 28 [cited 2024 Nov. 6];34(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226692
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