Development of less invasive surgical procedures for thoracic esophageal cancer

Abstract

In order to minimize the invasiveness of the operative procedure for thoracic esophageal cancer, several procedures have been introduced since January 1997. They included: (i) perioperative use of steroids; (ii) muscle-sparing thoracotomy without costectomy; (iii) preparation of the gastric tube with preservation of sufficient blood supply; (iv) reconstruction of the alimentary tract via posterior-mediastinal route; and (v) formation of anastomosis between the remaining esophagus and the gastric tube at a location between the gastroepiploic arteries of the gastric greater curvature. Twenty-one patients who did not receive preoperative chemoradiotherapy underwent the newly developed procedure, and were compared with those receiving the original procedure. Hospital mortality was zero, and postoperative systemic inflammatory response syndrome was suppressed. The mean postoperative hospital stay was 21.5 days, and the actuarial 3-year survival rate was 76.2%. From the comparison with those receiving the original procedure, it can be concluded that the newly developed procedures were effective in minimizing surgical invasiveness and were sufficiently curative in terms of cancer treatment.

Therapeutic management of elderly patients with esophageal cancer

“…Several reports identifi ed improvements in anesthesia, surgical techniques and devices, and postoperative care as factors that have reduced postoperative morbidity and mortality [10][11][12]. These factors have contributed to improved survival rates in elderly patients with esophageal cancer.…”

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

“…For the improvement of long‐term survival, it is essential to minimize mortality by optimizing surgical techniques and perioperative care 17, 18, 19. In addition, severe infections, pulmonary complications, and liver dysfunction require extended intensive care and long hospital stays for some patients 9, 20.…”

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

“…The included studies reported on a variety of eight cancer types: pancreatic adenocarcinoma [19,28], non-small-cell lung cancer [20,23,34], ovarian [21], rectal [22,33], colorectal [25,31], endometrial [26], oesophageal [27,29,30,32], and breast cancer [24]. Sample sizes range from 37 [27] to 2628 [24] patients and the follow-up periods from six months to ten years. The glucocorticoid exposures ranged from a single administration of low dose dexamethasone to repetitive very high doses of methylprednisolone.…”