World Journal of Surgery

, Volume 17, Issue 6, pp 760–764 | Cite as

Does esophagectomy cure a resectable esophageal cancer?

  • Issam El Nakadi
  • Jean -Jacques Houben
  • France Gay
  • Jean Closset
  • Michel Gelin
  • Jean -Pierre Lambilliotte
Original Scientific Reports

Abstract

During the years 1978–1990, 401 patients with esophageal cancer were evaluated for curative resection.

A retrospective study was undertaken to estimate the efficacy of surgery and select criteria for long-term survival.

After investigation, 187 patients (47%) underwent surgery. To evaluate the long-term results, 101 curative esophageal resections classified into stage I (11 patients), II (24 patients), and III, pathological TNM (66 patients), with at least 2 years' follow-up, were considered. Esophagogastrectomy was performed in 91% of the cases and gastric transposition was achieved in 96% of the patients.

The anastomoses were intrathoracic (98%) and at the apex of the right thorax for tumors of the middle third of the esophagus. Staplers were used in 76% of sutures. Postoperative hospital mortality was 5.9%. Specific morbidity included strictures 11%, esophagitis 12%, and anastomotic leak 2%.

Actuarial 5-year survival was 90.9% in stage I, 52.3% in stage II, and 17.7% in stage III. The overall 5-year survival rate was 34.2%, 64.8% for the No patients, and decreased to 17.7% when node involvement was observed. Five- to 8-year survival is also considered.

It is concluded from this study that esophagectomy is actually the appropriate treatment in patients with nonmetastatic resectable carcinoma with an overall 34.2% 5-year survival.

The operation can be performed with a low morbidity and mortality rate if done in experienced centers.

Keywords

Esophageal Cancer Anastomotic Leak Esophagitis Hospital Mortality Curative Resection 

Résumé

Pendant les années 1978–1990, les dossiers de 401 patients ayant un cancer de l'oesophage ont été analysés rétrospectivement dans le but d'évaluer l'efficacité de la chirurgie à visée curative et de déterminer les critères prédictifs d'une survie à long terme. Après un bilan préopératoire classique, 187 (47%) patients avaient été jugés opérables. Pour évaluer les résultats à long terme, on a analysé seulement les résultats de 101 patients ayant survécu 2 ans: 11 patients classés stade I (classification pTNM), 24 patients classés stade II et 66 patients classés stade III. Une esophagogastrectomie a été pratiquée chez 91% des patients. Une interposition gastrique a été réalisée chez 96%. L'anastomose était intrathoracique chez 98% et, pour les tumeurs du tiers moyen de l'esophage, réalisée au sommet du poumon droit. L'agraffeuse mécanique a été utilisée pour 76% des anastomoses. La mortalité postopératoire a été de 5.9%. La morbidité a comporté des sténoses chez 11%, de l'esophagite chez 12% et une fuite anastomotique chez 2% des patients. La survie actuarielle a été de 90.9% chez les patients stade I, de 52.3% chez les patients stade II et de 17.7% chez les patients stade III. La survie globale à 5 ans a été de 34.2%. De 64.8% pour les patients No, celle-ci est passée à 17.7% lorsque les ganglions lymphatiques étaient envahis. On conclue que l'esophagectomie est le traitement approprié des cancers non métastatiques, résecables de l'esophage et que la survie globale à 5 ans est de 34.2%. La morbidité et la mortalité sont basses lorsque l'intervention est réalisée par une équipe expérimentée.

Resumen

En el período 1987–1990 fueron evaluados 401 pacientes con cáncer del esófago en cuanto a resección curativa. Se realizó un estudio retrospectivo con el fin de determinar la eficacia de la cirugía y de seleccionar criterios para lograr sobrevida a largo plazo. Luego de la exploración clínica, 187 (47%) fueron sometidos a cirugía; 101 resecciones curativas fueron clasificadas según los estados PTNM: I (11 pacientes), II (24 pacientes) y III (66 pacientes), con no menos de dos años de seguimiento.

Se prático esofagogastrectomía en 91% de los casos; la transposición gástrica fue practicada en 96% de los pacientes. Las anastomosis fueron intratorácicas en 98% de los casos y a nivel del ápex del tórax derecho en los tumores del tercio medio del esófago. Se utilizaron grapas (suturas) mecánicas en 76% de los pacientes. La mortalidad hospitalaria fue 5.9%. La morbilidad específica incluyó: estenosis 11%; esofagitis, 12%; y fuga anastomótica, 2%. La supervivenvia actuarial fue 90.9% para el estado I, 52.3% para el estado II y 17.7% para el estado III. La tasa global de sobrevida a 5 años fue 34.28%, 64.8% para paciente No y disminuyó a 17.7% cuando había invasión ganglionar.

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Copyright information

© Société Internationale de Chirurgie 1993

Authors and Affiliations

  • Issam El Nakadi
    • 1
  • Jean -Jacques Houben
    • 1
  • France Gay
    • 1
  • Jean Closset
    • 1
  • Michel Gelin
    • 1
  • Jean -Pierre Lambilliotte
    • 1
  1. 1.Department of Digestive Surgery and Gastroenterology, Hôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium

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