Analysis of Reduced Death and Complication Rates After Esophageal Resection

Abstract

ObjectiveTo identify factors that have contributed to reduced rates of death and complications after esophageal resection in a 17-year period at a tertiary referral center. Summary Background DataThere has been an evolving refinement in surgical technique and perioperative management of patients undergoing esophageal resection at Queen Mary Hospital during the past two decades. As of the end of 1998, there had been no hospital deaths among the last 105 consecutive resections performed for esophageal squamous cancer. MethodsThe results of esophageal resection for squamous cell carcinoma were analyzed using a prospective esophageal database. A longitudinal study was performed to compare and analyze rates of death and complications for three consecutive time periods. ResultsThe study group comprised 710 patients who underwent one-stage esophageal resection between 1982 and 1998. A transthoracic esophagectomy was the preferred approach in 590 patients (83%). The overall hospital death rate was 11%. The leading causes of hospital death were pulmonary complications (45.5%) and progression of malignant disease (21.5%); anastomotic leakage accounted for 9% of deaths. During the study period, the hospital death rate decreased from 16% to 3.2%, and the incidence of postoperative respiratory failure decreased from 15.5% to 6.5%. Perioperative factors that correlated with the decreased death rate over time were the increased postoperative use of epidural analgesia and bronchoscopy (for clearance of pulmonary secretions), a decrease in history of smoking, and a decrease in surgical blood loss of more than 1,000 mL. ConclusionsIn this series of predominantly transthoracic esophagectomies, there has been a decline in the hospital death rate to less than 5%. These results are largely attributable to factors aimed at reducing postoperative pulmonary complications.

Management of Complications of Radical Esophagectomy

“…Wholely described necrosis of transposition in 0.8 % in sample of 710 patients [16]. The most common cause of necrosis is ischemia which is more frequent in coloplasty than gastroplasty.…”

Hand-Sewn Versus Stapled Esophagogastric Anastomosis in the Neck: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…With the development of surgical techniques, many advances have been applied to the surgery of esophageal cancer in the past decade [7,8]. Although lower rate of mortality has always been reported [9][10][11], the postoperative complications are proven to be frequently common, which included anastomotic leakage and stricture. Among the factors leading to the higher mortality, anastomotic leakage plays an essential role, with the rate ranging from 0 to 41 % [12].…”

Fístula cervical pós-anastomose esofagogástrica: é possível diminuir a ocorrência?

“…Atualmente, a seleção apurada de pacientes, associada ao aperfeiçoamento da anestesiologia, do rigor técnico e do manejo pré e pós-operatório em unidades de terapia intensiva resultaram em melhora significativa nas taxas de morbi-mortalidade destes pacientes 5,46,62 . Da mesma forma, a literatura evidencia que os bons resultados em procedimentos cirúrgicos complexos como a esofagectomia são volume dependentes 11,39,43,57 , com taxas de mortalidade hospitalar em serviços de excelência inferiores a 5% 62 .…”

“…Da mesma forma, a literatura evidencia que os bons resultados em procedimentos cirúrgicos complexos como a esofagectomia são volume dependentes 11,39,43,57 , com taxas de mortalidade hospitalar em serviços de excelência inferiores a 5% 62 .…”

“…Neste caso, apesar dos progressos em outras modalidades terapêuticas, a esofagectomia persiste como tratamento de escolha em pacientes com tumores potencialmente ressecáveis, tanto com intento curativo quanto paliativo. Entretanto, na afecção maligna, cerca de 75% dos pacientes já apresentam doença avançada no momento do diagnóstico 24,25,59,62 . O câncer de esôfago figura entre os tumores sólidos mais letais, sendo referido universalmente como a sexta causa de morte dentre as neoplasias.…”