SEARCH · PubMed Health

Results for “ESOPHAGECTOMY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources

PubMed1991

Transhiatal esophagectomy in the management of perforated esophageal cancer.

Instrumental perforation of esophageal malignancy is best managed by immediate esophagectomy. Transthoracic esophagectomy has been the technique most described in the management of patients with this injury. A recent series reported the successful use of transhiatal esophagectomy with primary cervical esophagogastrostomy in four patients with perforated esophageal cancers. We have also used this technique to treat a patient with instrumental perforation of a distal esophageal cancer. This case is presented to add to the published experience using transhiatal esophagectomy in the management of perforated esophageal malignancy. The merits of transhiatal esophagectomy warrant consideration of this approach as a useful alternative to transthoracic resection in the management of selected patients with perforated esophageal cancer.

Adenocarcinoma↗

PubMed1995

Mac-1 expression and superoxide generation of the peripheral polymorphonuclear leukocyte following gastrectomy and esophagectomy.

The aim of this study was to evaluate the characteristics of the polymorphonuclear leukocyte (PMN) function after surgical stress. We investigated Mac-1 expression and superoxide generation by peripheral PMNs and serum granulocyte-colony stimulating factor (G-CSF) concentrations in 15 patients who underwent either gastrectomy (n = 8) or esophagectomy (n = 7). The serum G-CSF rapidly increased within 24 hours after operation. The maximum levels of serum G-CSF in the cases of esophagectomy were about 5-8 fold those of gastrectomy, although the increases in PMN counts within 24 hours of esophagectomy were lower than those after gastrectomy. Mac-1 expression and superoxide generation by PMN counts and serum G-CSF. After esophagectomy, Mac-1 expression on peripheral PMNs remained elevated through the 7th day after operation, while superoxide generation by PMNs in response to PMA declined to below preoperative levels after the 3rd day. These results suggest that, after major surgery such as esophagectomy, there is a discrepancy between Mac-1 expression and superoxide generation by the peripheral PMN despite a high level of serum G-CSF.

Aged↗

PubMed1994

Tube jejunostomy as an adjunct to esophagectomy.

BACKGROUND: The safety and efficacy of various methods of accessing the intestinal tract, including needle catheter jejunostomy, have been well described. This review represents an evaluation of the Witzel tube jejunostomy as an adjunct to esophagectomy. METHODS: The records of 523 patients who underwent esophagectomy for benign or malignant disease from 1976 to 1991 were reviewed. Each patient underwent placement of a tube jejunostomy at the time of esophagectomy and esophageal reconstruction. Utilization of the jejunostomy tube and the complications related to its placement were examined. RESULTS: The feeding jejunostomy was used in all patients in the initial postoperative period, for more than 3 weeks in 11%, and for more than 2 months in 6.9%. Major complications related to the jejunostomy tube occurred in 11 patients (2.1%). There were no fatal complications. CONCLUSIONS: Tube jejunostomy is a useful adjunct to esophagectomy for providing enteral nutrition during the postoperative period. The Witzel jejunostomy as described herein is comparable in terms of safety, function, and complication rate to the needle catheter jejunostomy and has certain technical advantages. Routine use of tube jejunostomy is recommended in patients undergoing esophagectomy.

Adolescent↗

PubMed1995

Esophageal carcinoma metastatic to the brain: clinical value and cost-effectiveness of routine enhanced head CT before esophagectomy.

PURPOSE: To assess the value of screening enhanced head CT before esophagectomy for carcinoma, identify increased risk factor(s) for brain metastases, and determine metastasis incidence. METHODS: Thoracic surgery files of patients undergoing esophagectomies for squamous carcinomas, adenocarcinomas, and undifferentiated carcinomas between January 1984 and March 1993 were reviewed regarding sex, size (length) of neoplasm, and brain metastases. Surgical pathology and tumor registry files also were reviewed. Records of patients with brain metastases were reviewed in detail. RESULTS: Three hundred thirty-four esophagectomies were performed for 230 adenocarcinomas (202 male, 28 female) and 104 squamous carcinomas (61 male, 43 female). In 9 males and 1 female with adenocarcinomas and 1 male and 1 female with squamous carcinomas, brain metastases developed. Surgical pathology files identified 293 additional esophageal carcinomas, including 2 males with adenocarcinomas metastatic to brain. Tumor registry files identified I additional male with brain metastasis from an undifferentiated esophageal neoplasm. No statistically significant preoperative characteristic of esophageal carcinomas with proneness to brain metastases was found, except large size of primary neoplasm. Preoperative screening head CT done on approximately 240 patients who underwent esophagectomies showed no metastases. CONCLUSIONS: Brain metastases from carcinomas of the esophagus are relatively uncommon (3.6% in the esophagectomy cohort). They tend to occur in patients with large primary neoplasm, probably especially adenocarcinomas involving the esophagogastric junction, and with findings of local invasion and lymph node metastases by CT and/or microscopically. It may be reasonable to obtain head CT as a last preoperative staging procedure in such patients. Routine preoperative head CT for staging is not cost effective.

Aged↗

PubMed1980

Extrathoracic esophagectomy in the treatment of esophageal cancer.

Extrathoracic esophagectomy has the potential of improving the results of resectional therapy for carcinoma of the esophagus by eliminating the need for thoracotomy and decreasing postoperative pulmonary complications. This report compares the operative and functional results of blunt extrathoracic esophagectomy and substernal reversed gastric tube reconstruction in patients with esophageal cancer to results in 10 consecutive nonrandomized control patients treated by standard esophagogastrectomy. Extrathoracic esophagectomy was associated with greater pulmonary dysfunction than standard esophagogastrectomy. While there was no significant difference in survival in the two groups, three patients in the standard esophagogastrectomy group (mean survival 9.0 months) and none in the extrathoracic esophagectomy group (mean survival 7.4 months) developed anastomotic recurrence. Extrathoracic esophagectomy evidently does not afford patients with esophageal carcinoma better palliation than standard esophagogastrectomy.

Deglutition↗

PubMed1982

Esophagectomy: definitive treatment for esophageal neuromotor dysfunction.

Twenty-two patients with a history of between one and four (average of two) unsuccessful prior esophageal operations for neuromotor dysfunction were treated with esophageal resection and replacement. Eleven (50%) had recurred reflux esophagitis in association with various disorders of motility: esophageal spasm in 4, achalasia in 3, scleroderma in 2, and esophageal atresia in 2. Eight (36%) had primary esophageal spasm and 3 (14%) had achalasia. Esophageal obstruction, regurgitation, and severe spasm were the most common manifestations of the inability to swallow normally. Transthoracic or transhiatal (blunt) esophagectomies were performed in 5 and 17 patients, respectively. The stomach, with a cervical esophagogastric anastomosis, was used for esophageal substitution in 15 patients. Six patients underwent a long-segment colonic interposition, and 1 patient with achalasia underwent a distal esophagectomy and short-segment colonic interposition. One patient undergoing transthoracic esophagectomy for achalasia died from unrecognized intraoperative bleeding into the opposite chest. There were no other operative deaths. Additional complications included transient hoarseness in 8 patients, chylothorax in 1, and anastomotic leak in 1. After an average follow-up of 25 months for the 21 surviving patients, ability to eat is regarded as good in 18 (85%), fair in 1 (5%), and poor in 2 (10%). In patients with incapacitating esophageal neuromotor disease, a more radical operative approach-esophagectomy--may be safer and more reliable than attempting another procedure and risking another failure. Esophagectomy ensures definitive elimination of the esophageal problem and as optimal an ability to eat as possible. Our experience suggests that the stomach, with a cervical esophagogastric anastomosis, offers a better functional esophageal substitute than does a colonic interposition.

Adult↗

PubMed1984

Computerized axial tomography of the esophagus to determine the suitability for blunt esophagectomy.

Computerized axial tomographic (CT) scans were performed on 16 patients over an 18-month period to determine which patients were candidates for removal of their esophageal tumors by blunt esophagectomy. Blunt esophagectomy was offered only to those patients whose tumors were confined to the esophageal wall on CT scan. Thirteen patients were able to undergo blunt esophagectomy, with only one complication, a tracheal injury, which was repaired. Three patients had extensive mediastinal invasion requiring standard thoracotomy to perform a palliative resection. The operative blood loss in the group of patients with blunt esophagectomy was 500 ml, and there was only one operative death related to chronic aspiration. The CT scan is a valuable adjunct in determining which patients are candidates for esophagectomy without thoractomy.

Aged↗

PubMed1986

Adenocarcinoma of the distal esophagus and gastric cardia. Comparison of results of transhiatal esophagectomy and thoracoabdominal esophagogastrectomy.

Between 1965 and 1984, 72 patients underwent operation for adenocarcinoma of the distal esophagus or gastric cardia. A standard transthoracic esophagogastrectomy and esophagogastrostomy was performed in 43 and a transhiatal esophagectomy without thoracotomy and partial proximal gastrectomy was performed in 29. There was no significant difference between the two groups in age, sex, or TNM tumor staging. The perioperative complication rate was 86% in the esophagogastrectomy patients and 48% in the transhiatal esophagectomy patients (p less than 0.05). Mortality was higher in the esophagogastrectomy group (14%) than in the transhiatal esophagectomy group (7%). Average operative blood loss was greater in the esophagogastrectomy patients (2,510 versus 1,187 ml). Average postoperative hospitalization was longer for the esophagogastrectomy patients (22.2 days versus 12.3 days). Both differences are statistically significant (p less than 0.05). Late results, as evaluated by life-table analysis, showed no significant difference in survival between the two groups of patients. Because the morbidity and mortality rates of transhiatal esophagectomy are as low as or lower than those for esophagogastrectomy, late survival is as good, and palliation is superior (less suture-line tumor recurrence and reflux esophagitis), we believe that transhiatal esophagectomy is the preferred operative approach in patients with adenocarcinoma of the distal esophagus or gastric cardia.

Actuarial Analysis↗

PubMed1981

Comparison of the results of esophagectomy with and without a thoracotomy.

Two techniques of esophagectomy for carcinoma of the esophagus were compared in 41 patients. Of these, 39 had chemotherapy or radiotherapy, or both, preoperatively. Overall, the 20 patients who had a blind esophagectomy through an abdominal and a cervical incision without a thoracotomy tolerated the procedure quite well. However, two patients died three and five weeks afterward of arrhythmia and respiratory insufficiency, respectively. None of the 21 patients having an esophagectomy by means of a standard thoracotomy died. The blind esophagectomy took an hour less to perform and required slightly more blood than the standard thoracic esophagectomy. Except for the one patient who died of respiratory insufficiency, it appeared that the patients not having a thoracotomy had less pulmonary complications and required less ventilator assistance. The length of stay was almost identical. The main advantages found were the ease of the operation, no change needed in the position of the patient and the shorter duration of the operation. Theoretic advantages, not yet confirmed, include decreased mortality and morbidity if an anastomotic leak occurs and decreased change of local recurrence of the carcinoma.

Adenocarcinoma↗

PubMed2003

Extended esophagectomy with 3-field lymph node dissection for esophageal cancer.

OBJECTIVE: To review the surgical outcomes of extended esophagectomy with 3-field lymph node dissection (3FLND) for esophageal cancer. DATA SOURCES: Only articles written in English and written after 1980 were selected from MEDLINE. The following terms were identified: 3FLND, extensive or extended lymph node dissection (lymphadenectomy), radical lymph node dissection, cervical lymph node dissection, and extended or radical esophagectomy in esophageal cancer. STUDY SELECTION: There were no exclusion criteria for published information relevant to the topic. The most representative articles were selected when there were several articles from the same institution. Case reports were excluded. DATA EXTRACTION: Twenty-six articles were finally col-lected from MEDLINE. Eleven articles were also selected from reference lists of the pertinent literature. DATA SYNTHESIS: The collected information was organized. CONCLUSIONS: The conclusions drawn from those articles showed that extended esophagectomy with 3FLND would be a safe procedure in experienced hands, with low morbidity and acceptable mortality rates. When strict patient selection criteria were maintained, this procedure reduced locoregional recurrence and improved long-term survival rates. Although the therapeutic value of 3FLND is unproved in a randomized trial, extended esophagectomy with 3FLND would be the treatment of choice in selected patients.

Esophageal Neoplasms↗

PubMed1992

Transhiatal and transthoracic esophagectomy for adenocarcinoma of the esophagus.

Adenocarcinoma of the esophagus is no longer rare and is treated by resection. To determine whether the approach used for resection influences outcome, we studied 88 patients who underwent resection; 14 had stage I or II disease, 74 had stage III, and 40 had stage IV. One third of those with Barrett's esophagus were noted on screening endoscopy to have potentially curable disease; the others were diagnosed with stage III or IV disease. Transhiatal esophagectomy was performed in 63 patients; 24 patients underwent transthoracic esophagectomy. We found no difference in survival or morbidity between transhiatal and transthoracic esophagectomy. Overall 5-year survival for stage I and II disease was 86%. For stage III and IV disease, 5-year survival was 14.5%. Aggressive surveillance of Barrett's esophagus facilitates the discovery of early disease. Esophagectomy for adenocarcinoma can result in cure of early cancers and improved palliation of more advanced disease.

Adenocarcinoma↗

PubMed1994

Functioning of the intrathoracic stomach after esophagectomy.

OBJECTIVE: To investigate acid secretion and motility of the intrathoracic stomach with truncal vagotomy after esophagectomy. DESIGN: Case-control study of patients undergoing esophagectomy, with average follow-up of 3.2 months, compared with health controls. SETTING: Yamaguchi University School of Medicine, Kogushi, Japan. PATIENTS: A random sample of 21 patients selected from 79 patients with esophageal cancer during the period from May 1988 to August 1993 received the intrathoracic stomach after subtotal esophagectomy. A control sample consisted of 14 men. INTERVENTIONS AND MAIN OUTCOME MEASURES: For acid secretion, a pH probe was placed in the intrathoracic stomach to measure the average pH value (average of total monitoring values) and pH holding time (ratio of the period during which the pH value was 3 or higher based on the entire continuous monitoring periods). For motility, digestive tract scintigraphy was performed to obtain the time activity curve from the analog image observed when patients ate meals labeled with indium 111. In addition, hemorrhagic ulcers in the intrathoracic stomachs of three patients were reported. RESULTS: A pH value below 3 was recognized after surgery, and there was no significant difference between pH values in patients and normal volunteers (average pH value, 3.9 +/- 1.5 vs 3.3 +/- 1.9; pH holding time, 52.2 +/- 20.2% vs 57.1 +/- 24.4%, respectively). The time activity curve of the intrathoracic stomach observed by scintigraphy underwent no change after surgery. Among three patients with hemorrhagic ulcers, two exhibited improvements after receiving a histamine blocker, while in the other, it was not effective. CONCLUSION: Acid secretion ability and motility of the intrathoracic stomach with truncal vagotomy may be unchanged after esophagectomy.

Case-Control Studies↗

PubMed1995

A 15-year review of esophagectomy for carcinoma of the esophagus and cardia.

OBJECTIVE: To evaluate the effect of surgical approach and adjuvant therapy on patients with carcinoma of the esophagus and/or cardia. DESIGN: Retrospective analysis of 157 consecutive patients who underwent esophagectomy. SETTING: A private university medical center and its affiliated community hospital. PATIENTS: One hundred twenty men and 37 women (mean age, 61.7 years) with carcinoma of the esophagus and/or cardia that was surgically treated between 1978 and 1993. INTERVENTIONS: Three approaches were used for resection: Transhiatal esophagectomy (THE) (n = 67), transthoracic esophagectomy (TTE) (n = 71), and abdominal-only esophagectomy (AOE) (n = 19). Sixty-five patients received adjuvant radiotherapy and chemotherapy. MAIN OUTCOME MEASURES: Surgical mortality, morbidity, and survival and the effect of adjuvant therapy. RESULTS: The overall surgical mortality rate was 7.6%: 12.7% with the TTE, 4.5% with the THE, and 0% with the AOE approach. A significantly increased incidence of adult respiratory distress syndrome (P < .001) and empyema (P < .001) was seen with the TTE approach. The average intraoperative blood loss (P = .08) and the median intensive care unit stay (P = .26) and hospital stay (P = .40) were decreased with the THE and AOE approaches when compared with the TTE approach without significance. The overall median survival time was 17 months, with a 5-year survival rate of 21%. There was no significant difference in survival by pathologic stage between approaches. The addition of adjuvant therapy did not affect the overall median survival time or the 5-year survival rate. Node-positive patients did benefit from adjuvant radiotherapy and chemotherapy, with increased median survival times from 7 to 15 months and a 5-year survival rate from 0% to 15% (P = .01). CONCLUSIONS: The THE and AOE approaches have fewer early complications than does TTE. Both THE and TTE have equal long-term survival rates. Adjuvant therapy provides increased survival to node-positive patients with carcinoma of the esophagus and/or cardia.

Adult↗

PubMed1997

Laparoscopic total esophagectomy.

OBJECTIVE: To evaluate early results with laparoscopic total esophagectomy for benign and malignant disease of the esophagus. DESIGN: Case series involving 9 patients with mean follow-up of 13 months. SETTING: An advanced endoscopic surgery unit at a tertiary referral teaching hospital. PATIENTS: Between December 12, 1993, and December 1, 1996, 9 patients with a mean age of 61 years underwent laparoscopic esophagectomy. Indications were adenocarcinoma in 5, squamous cell carcinoma in 1, dysplastic Barrett esophagus in 2, and refractory stricture with severe shortening in 1. INTERVENTIONS: Gastroduodenal mobilization, transhiatal wide esophageal dissection, gastric tube formation (8 cases), pyloromyotomy (2 cases), cervical anastomosis (8 cases), and laparoscopic jejunal feeding tube placement (8 cases). OUTCOME MEASURES: Operative time, amount of blood loss, operative complications, length of hospital stay, postoperative complications, dysphagia rates, and survival. RESULTS: All procedures were completed endoscopically. Operative time was 6.5 hours (range, 4 3/4 to 9 1/4). Average blood loss was 290 mL. One patient required a right thoracoscopy for an intrathoracic anastomosis because of questionable viability of the gastric tube. Mean hospital stay was 6.4 days (range, 4-9 days). Hospital complications included subclavian vein thrombosis (1 patient), dysphonia (6 patients), and atelectasis (5 patients). There were no anastomotic leaks. Three patients subsequently died: 2 of distant metastatic cancer (at 13 months and 33 months) and 1 of cardiac failure at 10 months. The 6 surviving patients were cancer free at a mean follow-up of 13 months. One patient had left vocal cord paralysis. All patients were doing well and had Visick scores of I or II. CONCLUSIONS: Laparoscopic esophagectomy is a technically feasible but difficult procedure. Despite the long operative times, patients do well and benefit from a shorter hospital stay and more rapid recovery compared with open esophagectomy. Its role as a curative cancer procedure remains unknown, but it may have a place on the basis of its palliative superiority.

Adult↗

PubMed1997

Second primary carcinoma in the residual cervical esophagus after thoracic esophagectomy: report of five cases.

BACKGROUND AND OBJECTIVES: Development of second primary carcinomas after thoracic esophagectomy has become of much concern, because recently the prognosis of thoracic esophageal carcinoma after esophagectomy with extended lymph node dissection has been improving. We report our experience of diagnosing and treatment second primary carcinomas arising in the remaining esophagus after thoracic esophagectomy. METHODS: Among 253 patients who underwent esophagectomy for thoracic esophageal carcinoma more than 2 years previously, second primary esophageal carcinomas developed in five (2.0%), and these five patients were examined. RESULTS: All second primary carcinomas were found by endoscopy, and were diagnosed as superficial carcinoma (Tis or T1) of the residual cervical esophagus. One patient underwent laser irradiation, another endoscopic mucosal resection, two had surgical mucosectomy, and one segmental resection of the esophagus. After the second treatment, three patients were disease free for 37-38 months, one died of recurrent disease of the first carcinoma 36 months later, and one died of distant metastases of the second carcinoma 8 months later. There have been no local recurrences after treatments for the second primaries. CONCLUSIONS: A variety of low-trauma treatments were employed for the second carcinomas because they were found at an early stage. Endoscopic follow-up is proposed to detect second lesions at an early stage.

Carcinoma, Squamous Cell↗

PubMed1995

Can the morbidity of esophagectomy be reduced by the thoracoscopic approach?

Esophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity. We have made a prospective study of the results of 29 attempts of esophagectomy using a right thoracoscopic approach. There were 20 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 22 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient, and a caustic stenosis in 5. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis. There were five failures for the following reasons: unresectable carcinoma (one case), large tumor making a thoracoscopic dissection unsafe (two cases), and incomplete lung collapse making the exposure of the posterior mediastinum difficult (two cases). The average time of the thoracoscopic procedure was 135 min. The postoperative course was uneventful in all but five patients who had a pulmonary complication: atelectasis (three cases), right purulent pleural effusion (one case), acute respiratory disease syndrome (one case). The latter complication was lethal. Four out of five respiratory complications occurred in patients for whom the dissection was considered difficult. Among the other complications, there were five anastomotic leakages and three cases of laryngeal nerve palsy. The mortality rate was 3.8%. These initial results do not show a real benefit of the thoracoscopic approach for esophageal dissection, especially with respect to difficult esophagectomies. Further evaluation of the technique is needed.

Adenocarcinoma↗

PubMed1998

[Changes of serum cytokine levels after thoracoscopic esophagectomy].

We introduced thoracoscopic esophagectomy with extended lymphadenectomy for reduction of respiratory dysfunction and less surgical intervention in July 1995. In this study, we investigated the changes in serum interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) levels in 8 patients (TS Group) who underwent thoracoscopic esophagectomy with extended lymphadenectomy and compared them with the changes in patients who underwent conventional thoracotomy (CT Group). The duration of the operation and intrathoracic procedure in the TS group were significantly longer than in the CT group. However, the amount of blood loss and intrathoracic blood loss of the TS group were not significantly higher than in the CT group. The number of dissected lymph nodes was not significantly larger. The serum IL-6 levels reached maximum levels 3 hours from the end of operation. In the TS group, the changes in IL-6 levels were significantly larger (p < 0.05). On the other hand, the changes in CRP levels were also significantly larger (p < 0.01). Significant correlation was observed between the duration of the intrathoracic procedure and the maximum levels of IL-6. On the other hand, serum IL-1ra levels were not significantly. At present, these results suggest that the surgical intervention of thoracoscopic esophagectomy are more larger than that of conventional thoracotomy. We think that the length of intrathoracic procedure of thoracoscopic esophagectomy may make more large surgical stress.

Endoscopy↗

PubMed2005

[Esophagectomy as therapeutic principle for squamous cell esophageal cancer].

The fatalistic approach towards surgical therapy of esophageal squamous cell cancer has been replaced in recent years by a more differentiated view. This was triggered by the establishment of individualized therapeutic modalities based on tumor stage, tumor location, general patient status, and comorbidity. Despite advances in nonsurgical therapy of squamous cell esophageal cancer, esophagectomy remains the central therapeutic modality. Primary subtotal en-bloc esophagectomy with lymphadenectomy is the only curative option with a high likelihood of success for resectable tumors (uT1-3 categories) located below the level of the tracheal bifurcation and for early more proximal tumors. In patients with locally advanced tumors at or above the level of the tracheal bifurcation, surgical resection can still cure those who respond to neoadjuvant radiochemotherapy. Preoperative "conditioning" of risk patients, surgical safety strategies in risk situations, and standardization of both the operative procedure and the perioperative management have resulted in a marked reduction of the previously substantial postoperative mortality to below 3% in experienced centers. In our own experience of 900 esophagectomies for squamous cell esophageal cancer, the 5-year survival rate rose from about 20% to more than 50% in the last two decades. Esophagectomy thus has become a safe operation and remains the only therapeutic option offering cure for a substantial proportion of patients with squamous cell cancer of the esophagus.

Adenocarcinoma↗