Comparison of Early and Late Complications in Three Esophagectomy Techniques

Abstract

Background: Due to the high prevalence and mortality rates of esophageal cancer in some parts of the world and considering that in most patients, symptoms occur when cancer is advanced, this study aimed to compare early and late complications in three esophagectomy techniques for treatment of esophageal cancer. Methods: The present study was a descriptive research on 316 patients with esophageal cancer referring to Shohada Tajrish hospital, Tehran. The results were recorded in the research forms consisting of individual characteristics, symptoms and reasons for referring to the hospital. Findings were extracted after classification and evaluated using descriptive statistics. Results: Among 316 patients studied, 190 patients (60%) were male and 126 (40%) were female. The highest prevalence was between 40 and 60 years old. The most significant reason for referring to the hospital was dysphagia and weight loss. Among 260 patients, 72 patients (27.7%) underwent surgery by transthoracic (Ivor Lewis type) approach, 76 patients (29.2%) underwent surgery by threeincision approach (Mc Keown procedure), and 112 patients (43%) underwent surgery by Trans-Hiatal (Oringer). A total of 36 deaths occurred. 22 deaths occurred using Ivor-Lewis (61%), 10 deaths occurred using Mc Keown (27.7%) and 4 deaths occurred after Oringer (11.1%). In terms of prevalence of complications, the most common early complication was pleural effusion (11%) and the most common late complication was anastomotic stricture (17.8%). Conclusions:Complications occurred in all three surgeries. The most complications occurred using transthoracic (Ivor Lewis type) approach and the least complications occurred using Trans-Hiatal (Oringer).

Depth Analysis of Open Transhiatal Esophagectomy Outcomes (Orringer Technique) in Patients with Esophageal Cancer from 1990 to 2015: A 25-Year Experience Single-center Study

“…Until achieving this success, transhiatal esophagectomy is a suitable option for old, smoker, and malnourished patients with several comorbidities. The present study and experiences (1,2,10,11) indicated that non-radical surgery such as the Orringer technique is acceptable and compassable with radical esophagectomy.…”

“…Transhiatal esophagectomy (Orringer technique) is done through 2 incisions, 1 at the neck and the other at the abdomen, only lower mediastinal lymph nodes can be removed (1,11,12). This technique was associated with low mortality and morbidity in more extensive studies but with no survival difference (1,2,10,12). Mortality and morbidity in our series were lower than in its original series (3.5% vs. 4%) (11) perhaps due to technical and experimental issues.…”

“…In this study, transhiatal esophagectomy lost more long-term survival benefits compared to step-by-step. It seems that the mortality rate and complications after the transhiatal esophagus are lower (1,2). Suffice it to say that the debate over the best way for esophageal cancer remains an open question.…”

“…Lower mediastinal lymph node (LNS) basins can be resected in an Orringer like the upper abdominal LNS, which is an attractive option for GEJ cancers. Upper mediastinal LNS above the inferior pulmonary vein, which cannot be removed with this method, rarely leads to recurrent cancer recurrence (2).…”