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Biomedical subjects

M S Allen

Publications and source records attributed to M S Allen.

At least 19 recordsLinked to original sources
PubMed1999

Inflammatory pseudotumors of the lung.

BACKGROUND: Inflammatory pseudotumors of the lung are rare and often present a dilemma for the surgeon at time of operation. We reviewed our experience with patients who have this unusual pathology. METHODS: Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at the Mayo Clinic. Twenty-three patients (0.04%) had resection of an inflammatory pseudotumor of the lung. There were 12 women and 11 men. Median age was 47 years (range, 5 to 77 years). Six patients (26%) were less than 18 years old. All pathologic specimens were re-reviewed, and the diagnosis of inflammatory pseudotumor was confirmed. Eighteen patients (78%) were symptomatic which included cough in 12, weight loss in 4, fever in 4, and fatigue in 4. Four patients had prior incomplete resections performed elsewhere and underwent re-resection because of growth of residual pseudotumor. Wedge excision was performed in 7 patients, lobectomy in 6, pneumonectomy in 6, chest wall resection in 2, segmentectomy in 1, and bilobectomy in 1. Complete resection was accomplished in 18 patients (78%). Median tumor size was 4.0 cm (range, 1 to 15 cm). There were no operative deaths. Follow-up was complete in all patients and ranged from 3 to 27 years (median, 9 years). RESULTS: Overall 5-year survival was 91%. Nineteen patients are currently alive. Cause of death in the remaining 4 patients was unrelated to pseudotumor. The pseudotumor recurred in 3 of the 5 patients who had incomplete resection; 2 have had subsequent complete excision with no evidence of recurrence 8 and 9 years later. CONCLUSIONS: We conclude that inflammatory pseudotumors of the lung are rare. They often occur in children, can grow to a large size, and are often locally invasive, requiring significant pulmonary resection. Complete resection, when possible, is safe and leads to excellent survival. Pseudotumors, which recur, should be re-resected.

Adolescent↗
PubMed1999

Early and long-term results of prosthetic chest wall reconstruction.

OBJECTIVE: The purpose of this report is to evaluate our results in patients who underwent prosthetic bony reconstruction after chest wall resection. METHODS: We retrospectively reviewed all patients who underwent chest wall resection and reconstruction with prosthetic material at the Mayo Clinic. RESULTS: From January 1, 1977, to December 31, 1992, 197 patients (109 male patients and 88 female patients) underwent chest wall resection and reconstruction with prosthetic material. Median age was 59 years (range, 11-86 years). The indication for resection was recurrent chest wall malignancy in 65 patients (33.0%), primary chest wall malignancy in 62 patients (31.5%), contiguous lung or breast carcinoma in 58 patients (29.4%), and other reasons in 12 patients (6.1%). Three patients (1.5%) each had an open draining wound. This review covers 2 time periods. Sixty-four patients (32.5%) underwent reconstruction with polypropylene mesh during the period from 1977 to 1986. One hundred thirty-three patients (67.5%) underwent reconstruction with polytetrafluoroethylene from 1984 to 1992. Soft tissue coverage was achieved with transposed muscle in 116 patients (58.9%), local tissue in 81 patients (41.1%), and omentum in 3 patients (1.5%). There were 8 deaths (operative mortality rate, 4.1%). Ninety-one patients (46.2%) experienced complications. Seromas occurred in 14 patients (7.1%). Wound infections occurred in 9 patients (4.6%; 5 patients with polypropylene mesh and 4 patients with polytetrafluoroethylene). The prosthesis was removed in all 5 patients with polypropylene mesh and in none of the patients with polytetrafluoroethylene. Follow-up was complete in 179 operative survivors (94.7%) and ranged from 1 to 204 months (median, 26 months). A well-healed asymptomatic wound was present in 127 patients (70.9%). CONCLUSIONS: Chest wall resection and reconstruction with prosthetic material will yield satisfactory results in most patients. Little difference exists between polypropylene mesh and polytetrafluoroethylene.

Adolescent↗
PubMed1999

Results of reoperation on the upper esophageal sphincter.

OBJECTIVE: Reoperation on the upper esophageal sphincter is infrequent. We reviewed our experience in patients who underwent reoperation on the upper esophageal sphincter. METHODS: This is a retrospective report of accumulative series from 2 separate institutions. RESULTS: From September 1, 1976, to February 28, 1997, 37 patients underwent reoperation on the upper esophageal sphincter for recurrent or persistent obstructive symptoms. There were 29 men and 8 women. The median age was 69 years (range, 38-87 years). The original indication for the operation was a pharyngoesophageal (Zenker's) diverticulum in 33 patients (89.2%), oculopharyngeal dystrophy in 3 patients (8.1%), and muscular dystrophy in 1 patient (2.7%). One prior upper esophageal sphincter operation had been performed in 26 patients (70.3%), two operations in 9 patients (24. 3%), and three operations in 2 patients (5.4%). All patients were symptomatic; 35 patients (94.6%) had dysphagia; 23 patients (62.2%) had regurgitation; and 12 patients (32.4%) had episodes of aspiration. Thirty of the patients (91.0%) with Zenker's diverticulum were found to have a recurrent or persistent diverticulum at reoperation. A diverticulectomy and cricopharyngeal myotomy were performed in 23 patients (62.2%); cricopharyngeal myotomy alone, in 7 patients (18.9%); diverticulopexy and cricopharyngeal myotomy, in 6 patients (16.2%); and diverticulectomy alone, in 1 patient (2.7%). There were no operative deaths. Complications developed in 10 patients (27.0%). Follow-up was complete in 34 patients (91.9%) and ranged from 2 to 149 months (median, 39 mo). Thirty-two patients (94.1%) were improved. Functional results were classified as excellent in 26 patients (76. 5%), good in 2 patients (5.9%), fair in 4 patients (11.7%), and poor in 2 patients (5.9%). CONCLUSIONS: Reoperation for patients who have persistent or recurrent symptoms after an operation on the upper esophageal sphincter is associated with acceptable morbidity and mortality rates. Resolution of symptoms occurs in most patients.

Adult↗
PubMed1999

Treatment of epiphrenic diverticula.

Epiphrenic diverticulum is a rare disorder of the lower esophagus, thought to be related to an esophageal motility disorder. Treatment should involve removal of diverticulum and myotomy. Although the surgery is technically a difficult one, the long-term outcome should be excellent.

Diverticulum, Esophageal↗
PubMed1999

Effects of brown midrib 3 mutation in corn silage on dry matter intake and productivity of high yielding dairy cows.

The effects of enhanced in vitro neutral detergent fiber (NDF) digestibility of corn silage on dry matter intake (DMI) and milk yield were evaluated using 32 Holstein cows in a crossover design with 28-d periods. At the beginning of the experiment, cows were 89 d in milk and yielded 45.6 kg/d of milk. Experimental diets contained either brown midrib (bm3) corn silage or isogenic normal corn silage (control) at 44.6% of DM. The NDF digestibility estimated by 30-h in vitro fermentation was higher for bm3 corn silage by 9.7 units. Contents of NDF and lignin were lower for bm3 corn silage by 1.8 and 0.8 units, respectively. Diets were formulated to contain 19% crude protein and 31% NDF and to have a forage to concentrate ratio of 56:44. Daily DMI, milk yield (3.5% fat-corrected milk), and solids-corrected milk were 2.1, 2.6, and 2.7 kg higher, respectively, for cows fed bm3 corn silage. The milk protein and lactose contents were greater for bm3 treatment, but milk fat content was not. Individual milk yield responses of the cows to bm3 treatment were positively related to pretrial milk yield, and DMI response tended to be positively related to pretrial milk yield. Enhanced in vitro NDF digestibility was associated with higher energy intake, which resulted in increased milk yield.

Animals↗
PubMed1999

Evaluation of the importance of the digestibility of neutral detergent fiber from forage: effects on dry matter intake and milk yield of dairy cows.

Effects of the digestibility of neutral detergent fiber (NDF) from forage on performance of dairy cows were evaluated statistically using treatment means for 13 sets of forage comparisons reported in the literature. All comparisons reported significant differences in NDF digestibilities of forages in situ or in vitro. Treatment means were blocked by study or by additional factorial treatment within a study to remove variation among experiments. The statistical model included random effect of block, fixed factorial effect of NDF digestibility (high or low), and dietary NDF concentration as a covariate. Enhanced NDF digestibility of forage significantly increased dry matter intake (DMI) and milk yield. A one-unit increase in NDF digestibility in vitro or in situ was associated with a 0.17-kg increase in DMI and a 0.25-kg increase in 4% fat-corrected milk. Differences in NDF digestibility between treatments were greater when measured in vitro or in situ than when measured in vivo. Digestibility of NDF in vitro or in situ might be a better indicator of DMI than NDF digestibility in vivo because forages with high in vitro or in situ NDF digestibilities might have shorter rumen retention times, allowing greater DMI at the expense of NDF digestibility in vivo. Digestibility of NDF is an important parameter of forage quality.

Animals↗
PubMed1999

Effect of energy and protein density of prepartum diets on fat and protein metabolism of dairy cattle in the periparturient period.

To determine if increased nutrient density in prepartum diets improves nutrient balance of peripartum cows, we blocked 40 Holstein cows and 40 heifers by expected date of parturition and assigned them randomly within blocks to one of four treatment diets varying in density of net energy for lactation (NEL) and crude protein (CP). Diets were 1.30 Mcal of NEL/kg and 12.2% CP, 1.49 Mcal of NEL/kg and 14.2% CP, 1.61 Mcal of NEL/kg and 15.9% CP, and 1.48 Mcal of NEL/kg and 16.2% CP. These diets were fed ad libitum from 25 d prepartum until parturition, and all cows were fed the same diet after calving. Increased nutrient-density of prepartum diets did not decrease feed intake. Compared to animals fed the lowest density, those fed the highest density consumed more NEL (20 vs. 14 Mcal/d) and gained more body condition, backfat, and body weight. They also had less nonesterified fatty acids in plasma (176 vs. 233 microM) and more insulin-like growth factor-I in plasma (472 vs. 390 ng/ml) during the last 2 wk prepartum and less triglyceride in liver at parturition (0.9 vs. 1.5%, wet tissue basis). Quadratic effects of energy density were not observed, and the addition of protein in the medium energy diet had no effect. Prepartum diets did not alter any variables during lactation. In conclusion, increasing the energy and protein density up to 1.6 Mcal of NEL/kg and 16% CP in diets during the last month before parturition improves nutrient balance of cattle prepartum and decreases hepatic lipid content at parturition.

Animal Nutritional Physiological Phenomena↗
PubMed1999

A dairy herd model for use in whole farm simulations.

A dairy herd submodel was created for integration with other farm submodels to form DAFOSYM, a dairy farm simulation model. The herd submodel determines the best mix of available feeds to meet the fiber, energy, and protein requirements for each of six animal groups. The groups are early-, mid-, late-, and nonlactating cows, heifers over 1 yr old, and younger heifers. Feed intake, milk production, and manure dry matter and nutrient (N, P, and K) excretions are functions of the nutrient content of the diets. Required feed characteristics include crude protein, rumen degradable protein, acid detergent insoluble protein, net energy of lactation, neutral detergent fiber, total digestible nutrients, P, and K concentrations. Feed intake is predicted with fill and roughage units. These units are functions of feed neutral detergent fiber adjusted for particle size distribution and the relative rate of ruminal digestibility or physical effectiveness of the fiber. The herd submodel predicted feed intakes, nutrient requirements, diets, and manure excretions similar to those recommended or measured for dairy animals. When integrated with other farm components in DAFOSYM, the comprehensive model provides a useful tool for evaluating the long-term performance and economics of alternative dairy farm systems.

Animal Feed↗
PubMed1999

Alpha1-antitrypsin deficiency allele carriers among lung cancer patients.

Lung cancer (LC) and chronic obstructive pulmonary lung diseases (COPDs; including emphysema and chronic bronchitis) share a common etiology. Despite the known associations of alpha1-antitrypsin deficiency (alpha1AD) with COPD and COPD with LC, few studies examined the association of alpha1AD alleles and LC. We hypothesize that heterozygous individuals who carry a deficient allele of the alpha1AD gene Pi (protease inhibitor locus) are at an increased risk of developing LC. The Pi locus is highly polymorphic with >70 variants reported. There are at least 10 alleles associated with deficiency in alpha1-antitrypsin. Using an exact binomial test, we compared the alpha1AD carrier rate in 260 newly diagnosed Mayo Clinic LC patients to the reported carrier rate in Caucasians in the United States (7%). alpha1AD carrier status, determined by isoelectric focusing assay, was examined with respect to the history of cigarette smoking, COPD, and histological types. Thirty-two of the 260 patients (12.3%; 95% confidence interval, 8.6-16.9%) carried an alpha1AD allele, which was significantly higher than expected (P = 0.002). Twenty-four of the 32 carriers had allele S, 6 had allele Z, and 2 had allele I. Patients who never smoked cigarettes were three times more likely to carry a deficient allele (20.6%; P = 0.008), although smokers had a higher carrier rate (11.1%; P = 0.025) when compared with the 7% rate. Patients with squamous cell or bronchoalveolar carcinoma had a significantly higher carrier rate than expected (15.9% and 23.8%, P < or = 0.01, respectively). Our preliminary findings suggest that individuals who carry an alpha1AD allele may have an increased risk for developing LC, specifically squamous cell or bronchoalveolar carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1998

Zenker's diverticulum in the elderly: is operation justified?

BACKGROUND: Surgical correction of symptomatic Zenker's diverticulum is effective; however, elderly symptomatic patients may be denied surgical intervention because of perceived increased risks. METHODS: To address this concern, we reviewed 75 patients (46 men and 29 women) found to have this condition during the past two decades. RESULTS: Median age was 79 years (range, 75 to 91 years). Preoperative symptoms included dysphagia in 69 patients (92%), regurgitation in 61 (81%), pneumonia in 9 (12%), halitosis in 3 (4%), and weight loss in 1 (1%). Gastroesophageal reflux symptoms were noted in 27 patients (36%). Diagnosis was made by barium swallow in 63 patients, esophagoscopy in 5, and a combination of both in 7. Surgical procedures included both diverticulectomy and myotomy in 57 patients (76%), myotomy alone in 9 (12%), diverticulopexy and myotomy in 5 (7%), and diverticulectomy alone in 4 (5%). There was no in-hospital mortality. Complications occurred in 8 patients (11%) and included esophagocutaneous fistula in 4, pneumonia and urinary tract infection in 1, and wound infection, myocardial infarction, and persistent diverticulum in 1 each. Follow-up was available in 72 patients (96%) and ranged from 8 days to 17 years (median, 3.3 years). At follow-up, 64 patients (88%) were asymptomatic and 4 (6%) were improved with minimal symptoms. The remaining 4 patients (6%) have had varying degrees of dysphagia and all have been treated with periodic esophageal dilations. CONCLUSIONS: Operation for symptomatic Zenker's diverticulum in the elderly is safe and effective and will result in resolution of symptoms and improved quality of life in most patients.

Aged↗
PubMed1998

Leiomyosarcoma of the esophagus: results of surgical treatment.

BACKGROUND: This study examined the results of surgical treatment of leiomyosarcoma of the esophagus. METHODS: Between January 1920 and December 1996, 17 patients (9 men and 8 women) with leiomyosarcoma of the esophagus were treated surgically at the Mayo Clinic. Median age was 58 years and ranged from 26 to 76 years. Symptoms included dysphagia in 11 patients (64.7%) and odynophagia in 6 (35.3%). The tumor was located in the middle third of the esophagus in 10 patients (58.8%) and in the cervical esophagus in 7 (41.2%). Procedures performed included esophagogastrectomy in 9 patients (Ivor Lewis in 5, left thoracoabdominal in 3, and transhiatal in 1), enucleation in 3, transgastric excision in 1, and exploration without resection in 4. RESULTS: The procedure was considered curative in 11 patients (64.7%). There was one operative death (mortality, 5.9%). Complications occurred in 3 patients (17.6%) and included anastomotic leak in 2 and bleeding requiring reoperation in 1. Growth pattern was infiltrating in 7, polypoid in 5, and intramural in 5. Histologically, the tumor was grade 1 in 6 patients, grade 2 in 2, grade 3 in 7, and grade 4 in 2. The tumor was postsurgically classified as stage I in 2 patients, stage IIA in 7, stage IIB in 1, stage IIIA in 5, stage IV in 1, and unknown in 1. Six patients (35.3%) received adjuvant treatment. Follow-up was complete in 16 patients (94.1%) and ranged from 1 to 182 months (median, 48 months). Five- and 10-year actuarial survivals were 47.0% and 31.0%, respectively. Seven patients (41.2%) are currently alive (median survival, 72 months); all underwent curative resection. Factors affecting survival included completeness of resection, growth pattern, postsurgical stage, tumor grade, and tumor location (p < 0.05). CONCLUSIONS: We conclude that leiomyosarcoma of the esophagus is rare. Complete resection provides long-term survival.

Adult↗
PubMed1998

Uncut Collis-Nissen fundoplication: learning curve and long-term results.

BACKGROUND: Between September 1985 and July 1990, the first 100 consecutive patients (50 female and 50 male) undergoing primary uncut Collis-Nissen fundoplication performed by one surgeon were reviewed. METHODS: Median age was 62 years and ranged from 19 to 89 years. Indications for repair included gastroesophageal reflux in 56 patients, obstructive symptoms in 34, and a combination of both in 10. An upper gastrointestinal endoscopy was performed in 99 patients; all were abnormal. Esophagitis was documented in 53 patients, large diaphragmatic hernia in 36, stenosis in 18, "Cameron's erosions" in 17, Barrett's disease in 13, and other findings in 9 patients. An abnormal upper gastrointestinal series was demonstrated in 96 of 97 patients evaluated. Motility studies were performed in 95 patients, and 11 had abnormal peristalsis. All procedures were performed through a left thoracotomy. RESULTS: Complications occurred in 23 patients and included respiratory failure in 6, atrial fibrillation in 3, atelectasis in 3, pneumonia in 2, myocardial infarction in 2, and chylothorax, severe dysphagia, early breakdown of repair, cardiac tamponade, hematuria, spinal headache, and intraoperative perforation by dilator in 1 each. There were 2 postoperative deaths, both cardiac in origin. Median hospitalization was 8 days (range, 6 to 76 days). The first 25 patients had 10 complications (40%) and 2 deaths (8%). The remaining 75 patients had 13 complications (17%) and no deaths (mortality, p = 0.06; morbidity, p = 0.03). Follow-up was complete in all patients for a median of 100 months (range, 3 to 138 months). Eighty-six of the 98 operative survivors are currently alive. At last follow-up, excellent functional results were observed in 58 patients (59%), good in 24 (25%), fair in 8 (8%), poor in 7 (7%), and unknown in 1 (1%). CONCLUSION: We conclude that the uncut Collis-Nissen fundoplication provides good to excellent long-term results in 84% of patients. Operative mortality and morbidity is acceptable but is associated with a learning curve.

Adult↗
PubMed1998

Early experience and learning curve associated with laparoscopic Nissen fundoplication.

BACKGROUND: Laparoscopic approach for hiatal hernia repair is relatively new. Information on the learning curve is limited. METHODS: From January 1994 to September 1996, 280 patients underwent antireflux surgery at our institution. A laparoscopic repair was attempted in 60 patients (21.4%). There were 38 men and 22 women. Median age was 49 years (range 21 to 78 years). Indications for operation were gastroesophageal reflux in 59 patients and a large paraesophageal hernia in one. A Nissen fundoplication was performed in all patients; 53 (88.3%) had concomitant hiatal hernia repair. RESULTS: In eight patients (13.3%) the operation was converted to an open procedure. Median operative time for the 52 patients who had laparoscopic repair was 215 minutes (range 104 to 320 minutes). There were no deaths. Complications occurred in five patients (9.6%). Median hospitalization was 2 days (range 1 to 5 days). Median operative time and median hospitalization were significantly longer in the first 26 patients than in the subsequent 25 patients (248 vs 203 minutes and 2 days vs 1 day, respectively; p = 0.03). Seven of the first 30 patients (23.3%) required laparotomy as compared with two of the second 30 (6.7%) (p = 0.07). Follow-up in the 51 patients who had laparoscopic fundoplication for reflux was complete in 50 (98.0%) and ranged from 7 to 38 months (median 13 months). Functional results were classified as excellent in 34 patients (68.0%), good in 6 (12.0%), fair in 7 (14.0%), and poor in 3 (6.0%). Three patients were reoperated on for recurrent reflux symptoms at 5, 5, and 11 months. CONCLUSIONS: We conclude that laparoscopic Nissen fundoplication can be performed safely. The operative time, hospitalization, and conversion rate to laparotomy are higher during the early part of the experience, but all are reduced after the learning curve.

Adult↗
PubMed1998

Modeling ruminal digestibility of carbohydrates and microbial protein flow to the duodenum.

Carbohydrates are the major source of energy for dairy cows and for microbial protein synthesis in the rumen. The prediction of ruminal carbohydrate digestibility and of the flow of microbial protein to the small intestine is difficult because of the variability among various feeds in the kinetics of digestion and passage of neutral detergent fiber and starch. Disappearance of fiber and starch in vitro or in situ and gas production in vitro have been extensively evaluated, improved, and reviewed. Similarly, markers and models to measure ruminal passage rate have been extensively researched and improved. Sources of variation and decreased accuracy for these techniques are discussed. Variation and potential errors also remain for the prediction of microbial protein flow to the duodenum using in vivo procedures. However, when in vivo results were accumulated into a database, microbial N flow to the duodenum over a wide range of conditions could be predicted accurately by intake of net energy for lactation or by dry matter intake and percentage of neutral detergent fiber in the diet. Although evaluation of feeding interactions and specific dietary limitations for microbial protein production in the rumen are possible with some models but not with this regression approach, mechanistic models need further validation and more accurate rate constants for improved accuracy over a wide range of conditions.

Animals↗
PubMed1998

Open repair of hiatus hernia: thoracic approach.

Open repair of a hiatal hernia remains an excellent method for correction of symptomatic gastroesphageal reflux. This article gives a technical description of the performance of the Belsey Mark IV hiatal herniorrhaphy and the uncut Collis-Nissen repair. A brief description of preoperative evaluation and results is also included.

Fundoplication↗
PubMed1997

The impact of surgical adjuvant thoracic radiation therapy for patients with nonsmall cell lung carcinoma with ipsilateral mediastinal lymph node involvement.

BACKGROUND: Previous nonsmall cell lung carcinoma studies have shown that patients with ipsilateral mediastinal (N2) lymph node involvement who underwent surgical resection have a greater local recurrence rate than those with less lymph node involvement (N0, N1). Therefore, it was hypothesized that complete surgical clearance of subclinical lymph node disease is difficult in N2 patients and that adjuvant postoperative thoracic radiotherapy (TRT) may be beneficial. METHODS: A retrospective review was performed to determine the local recurrence and survival rates for patients with N2 disease undergoing complete surgical resection with or without adjuvant TRT. Between 1987 and 1993 at the Mayo Clinic, 224 patients underwent complete resection of N2 nonsmall cell lung carcinoma. More than one mediastinal lymph node station was sampled in 98% of patients; 39% then received adjuvant TRT (median dose, 50.4 grays). RESULTS: The median follow-up time was 3.5 years for the patients who were alive at the time of the analysis. The surgery alone versus surgery plus TRT groups were well balanced with respect to gender, age, histology, tumor grade, number of mediastinal lymph node stations dissected or involved, and involved N1 lymph node number. There were slightly more patients with right lower lobe lesions (compared with other lobes), patients with multiple lobe involvement, and patients with only one N2 lymph node involved in the surgery alone group. After treatment with surgery alone, the actuarial 4-year local recurrence rate was 60%, compared with 17% for treatment with adjuvant TRT (P < 0.0001). The actuarial 4-year survival rate was 22% for treatment with surgery alone, compared with 43% for treatment with adjuvant TRT (P = 0.005). On multivariate analysis, the addition of TRT (P = 0.0001), absence of superior mediastinal lymph node involvement (P = 0.005), and fewer N1 lymph nodes involved (P = 0.02) were independently associated with improved survival rate. CONCLUSIONS: This study, which to the authors' knowledge is the largest evaluating adjuvant TRT in N2 nonsmall cell lung carcinoma, suggests that adjuvant TRT may improve local control and survival.

Carcinoma, Non-Small-Cell Lung↗
PubMed1997

Esophageal resection for cancer of the esophagus: long-term function and quality of life.

BACKGROUND: Information on function and quality of life of long-term survivors after esophageal resection for carcinoma is limited. METHODS: Between 1972 and 1990, 359 patients underwent esophagectomy for stage I or II esophageal carcinoma at Mayo Clinic. We evaluated long-term function and quality of life in 107 of these patients (81 men and 26 women) who survived 5 or more years. Median age at operation was 62 years (range, 30 to 81 years). The operation performed was an Ivor Lewis resection in 77 patients (72%), transhiatal esophagectomy in 14 (13%), extended esophagectomy in 4 (4%), thoracoabdominal esophagectomy in 4 (4%), and other in 8 (7%). Adenocarcinoma was present in 72 patients (67%), squamous cell carcinoma in 28 (26%), and other in 7 (7%). Thirty-four patients (32%) were in postsurgical stage I, 65 (61%) in stage IIA, and 8 (8%) in stage IIB. Median survival was 10.2 years (range, 5.0 to 23.2 years). Follow-up was complete for all patients. RESULTS: Gastroesophageal reflux was present in 64 patients (60%), symptoms of dumping in 53 (50%), and dysphagia to solid food in 27 (25%). Seventeen patients (16%) were asymptomatic. Factors affecting late functional outcome were analyzed. Patients who had a cervical anastomosis had significantly fewer reflux symptoms (p < 0.05). Dumping syndrome occurred more frequently in younger patients (p < 0.05) and women (p < 0.01). Quality of life was assessed separately by the Medical Outcomes Study 36-Item Short-Form Health Survey and compared with the national norm. Scores measuring physical functioning were decreased (p < 0.01). Scores measuring ability to work, social interaction, daily activities, emotional dysfunction, perception of health, and levels of energy were similar. Mental health scores were higher (p < 0.05). CONCLUSIONS: We conclude that long-term functional outcome after esophagectomy for esophageal carcinoma is affected by age, sex, and type of reconstruction. Quality of life as judged by the patients is similar to the national norm.

Actuarial Analysis↗