Esophagectomy with or without thoracotomy

Tilanus, Hugo W.; Hop, Wim C. J.; Langenhorst, B. L. A. M.; Lanschot, J.J.B. van

doi:10.1016/s0022-5223(19)34163-7

Cited by 83 publications

(22 citation statements)

References 22 publications

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“…One approach involves transthoracic esophagectomy (TT), whilst the other uses transhiatal esophagectomy (TH). 1 The transthoracic approach is associated with expanded tissue damage, higher incidence of significant blood and fluid loss and significantly longer operation time. 2 However, recent meta-analyses suggest that there is no significant difference in the long term outcome between the two procedures.…”

Section: Introductionmentioning

confidence: 99%

Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy?

Márton¹,

Szakmány²,

Papp

et al. 2005

Diseases of the Esophagus

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Several techniques for esophageal resections have been reported. However, clear clinical evidence is still lacking whether any of the procedures is superior to the others regarding morbidity and mortality in the early postoperative period. Two operative approaches for esophageal carcinoma, transhiatal and transthoracic, were compared with respect to operative morbidity, mortality and systemic inflammatory response. In our prospective study between 2000 and 2002 83 patients were investigated. In a retrospective post hoc analysis patients were divided into two groups due to the performed operational procedure, transhiatal (TH) or transthoracic (TT). Multiple Organ Dysfunction Score (MODS) was monitored daily (t1,t2,t3). Serum procalcitonin (PCT) levels were determined on admission to the ICU (t0), then 24 hourly (t24,t48,t72). Microalbuminuria (M:Cr) was measured before (tp), and after surgery (t0,t6,t24,t48,t72). For statistical analysis Wilcoxon rank sum test, Mann-Whitney U-test and chi-square test were used as appropriate. We examined 52 patients in the TH group, and 31 patients in the TT group. There was no significant difference between the two groups regarding age, male/female ratio, and SAPS II scores. Operations lasted significantly longer in the TT group: 375 (300-480) min compared to the TH group 240 375 (180-319) min, P < 0.001. ICU mortality was similar in both groups (TH: 46 survivors/6 non-survivors; TT: 27 survivors/4 non-survivors; P = 0.607, respectively). Daily MODS did not differ significantly between the two groups. The observed inflammatory markers (PCT and M:Cr) followed the pattern we described earlier, without significant difference. In this study there was no difference in the clinical and biochemical variables of the patients between the transthoracic and transhiatal groups. The observed early postoperative morbidity and mortality may indicate, that both procedures can be considered as procedures with similar postoperative risk.

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Section: Introductionmentioning

confidence: 99%

Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy?

Márton¹,

Szakmány²,

Papp

et al. 2005

Diseases of the Esophagus

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“…Esophageal resection and reconstruction to treat cancer patients requires both thoracotomy and laparotomy, one of the most invasive procedures in GI tract surgery [1,2]. Selecting the most appropriate surgical approach has to be individualized and determined by the intent of surgery (curative or palliative), anatomic location of the tumor (cervical or thoracic) and the preferred method of reconstruction (colonic interposition or gastric pull-up).…”

Section: Discussionmentioning

confidence: 99%

“…Intrathoracic anastomosis after distal esophagectomy is a less invasive procedure, with lower mortality and morbidity, as compared to subtotal esophagectomy and cervical anastomosis. The stomach is frequently used to replace the distal esophagus for intrathoracic anastomosis [2]. When the stomach cannot be used, the invasive procedure with anastomosis between the cervical esophagus and the colon has to be done.…”

Section: Introductionmentioning

confidence: 99%

Successful reconstruction using a proximal gastric tube for synchronous carcinomas of the esophagus and the stomach

Ohno

Saeki

Kawaguchi

et al. 2001

Journal of Surgical Oncology

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“…A potentially harmful surgical complication is anastomotic leak. It does not appear to be related to technique (onelayer versus two-layer versus stapled anastomosis), but it is more frequently reported when a cervical esophageal anastomosis is performed [24,34]. However, cervical leaks are easily managed conservatively and seldom result in mortality.…”

Section: Morbidity and Mortalitymentioning

confidence: 98%

“…As noted previously, controversy has raged over whether surgical approach (transhiatal versus transthoracic) alters the rate and type of complications. Table 3 compares complications after transthoracic esophagectomy reported in four recent series [24,[32][33][34]] to a collected review of 1,192 patients undergoing transhiatal esophagectomy [35].…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

Surgical Management of Esophageal Carcinoma

Reed

1999

The Oncologist

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Surgical management of esophageal carcinoma is reviewed. The anatomy and biology are briefly mentioned, since these factors mitigate against the success of surgery. Staging, the key to proper treatment allocation and prognosis, is discussed, including the use of endoscopic ultrasonography, positron emission tomography, and thoracoscopy/laparoscopy. Patient selection and preparation for surgery are important considerations. Surgical techniques are then discussed, as are the advantages and disadvantages of various approaches, the morbidity of surgical resection, survival, and quality‐of‐life issues. Adjuvant treatment strategies (preoperative radiation, induction chemotherapy, induction chemoradiotherapy, and postoperative treatment) are summarized.

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Esophagectomy with or without thoracotomy

Cited by 83 publications

References 22 publications

Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy?

Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy?

Successful reconstruction using a proximal gastric tube for synchronous carcinomas of the esophagus and the stomach

Surgical Management of Esophageal Carcinoma

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