Tubo gástrico isoperistáltico de grande curvatura gástrica com sutura mecânica no tratamento cirúrgico do câncer de esôfago irressecável

Self Cite

-Background: Even though the esophageal cancer has innumerous treatment options its prognosis is still unsettled. Because esophagectomy is rarely curative, new and emerging therapies come to light such as isolated chemotherapy and radiotherapy or combined chemoradiation, followed or not by surgery. The rescue esophagectomy is an alternative for those patients with recurrent or advanced disease. Aim: To evaluate the results of the rescue esophagectomy in patients with esophageal cancer who had previously undergone chemoradiation and describe local and systemic complications of the procedure. Methods: Eighteen patients with unresectable esophageal squamous cell carcinoma were treated with chemoradiation followed by rescue esophagectomy. All of them presented the preoperative clinical conditions required to indicate the surgical procedure. Transthoracic esophagectomy with right side thoracotomy plus midline laparotomy was performed. Patients were evaluated with regard to any postoperative complications. Results: There were five patients with evidence of fistula at the level of the anastomosis, and four of them progressed satisfactorily. Postoperative dilation was needed in five out of eighteen patients due to stenosis of the esophagogastric suture line. Seven patients did develop pulmonary infection with a fatal outcome for two of them. Among the patients who were available for a five-year follow-up, there was a rate of 53.8% of disease-free survival. Conclusions -These patients presented an elevated morbidity of the procedure related to many factors such as the long period between chemoradiation and surgery, which leads to tissue injury resulting in anastomotic fistulas. Nevertheless, esophagectomy seems to be valuable in cases without any other therapeutic option. RESUMO -Racional:Apesar das inúmeras opções terapêuticas, o prognóstico da neoplasia maligna de esôfago continua sombrio. Devido à baixa taxa de cura da esofagectomia, foram desenvolvidas novas propostas de tratamento como a quimioterapia e radioterapia isoladas ou associadas, concomitante ou não à cirurgia, além da quimiorradiação exclusiva. A esofagectomia de regaste surge como opção terapêutica para aqueles pacientes com recorrência ou persistência da doença após tratamento clínico. Objetivo: Avaliar os resultados da esofagectomia de resgate em pacientes com câncer de esôfago submetidos previamente à quimiorradiação exclusiva, assim como descrever as complicações locais e sistêmicas. Método: Foram analisados retrospectivamente 18 pacientes com diagnóstico inicial de carcinoma epidermóide de esôfago irressecável, submetidos previamente à quimiorradioterapia. Após o tratamento oncológico eles foram examinados quanto às suas condições clínicas pré-operatórias. Foi realizada a esofagectomia por toracotomia direita e reconstrução do trânsito digestivo por cervicolaparotomia. Os mesmos foram avaliados no período pós-operatório tanto em relação às complicações locais e sistêmicas como em relação à qualidade de vida. Resultados: As complicações fora...

Section: Discussionmentioning

confidence: 94%

Avaliação das complicações da esofagectomia de resgate na terapêutica cirúrgica do câncer de esôfago avançado

Aquino

Said

Pereira

et al. 2013

Self Cite

“…It has been shown that the stapler, because it provides double inverted and better coaptation of the anastomotic site, favors the reduction of this complication 3,6,8,20 . However, the fistula subsequent to cervical esophagogastric anastomosis is controlled in most cases, with conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

Análise das complicações da esofagectomia transmediastinal no tratamento cirurgico do megaesôfago recidivado

Aquino¹,

Said²,

Leandro‐Merhi³

et al. 2011

Self Cite

headings -Esophagectomy. Esophageal ahalasia.abstRact -Background -The best option for the treatment of patients with achalasia and recurrent symptoms after previous treatment, has always been very controversial. In literature review, there is no surgical technique considered the best to deal with this condition. The idea to use a more selective treatment with transmediastinal esophagectomy without thoracotomy in patients with advanced megaesophagus in relapsed cases after prior cardiomyotomy can be considered. Aim -To evaluate the results of transmediastinal esophagectomy in recurrent megaesophagus regarding local and systemic complications. Methods -Thrity two patients were treated with recurrent symptoms after previous surgery to achalasia and indication for esophagectomy with gastric transmediastinal transposition through the posterior mediastinum for grade IV megaesophagus. They were 25 men (78.1%) and seven women (21.9%), aged from 34 to 72 years. All underwent previous myotomy varying from five to 39 years to the day of transmediastinal esophagectomy. Results -Some patients had complications. Among these, eight had pulmonary infection (25.0%) resulting in good outcome to the specific clinical treatment; two died due to hemodynamic effect caused by injury to the azygos vein and the other due to trachea injury; nine (28.1% ) had cervical esophagogastric anastomotic dehiscence doing well with conservative treatment. Of the 21 patients in whom monitoring was carried out in the long term -six months to 14 years -, 17 reported good swallowing solids and pastes, four (19.0%) had gastroesophageal reflux with clinical improvement with specific medical treatment. Conclusions -Transmediastinal esophagectomy, although providing adequate swallowing in most cases, is a procedure of high morbidity. This technique should not be recommended as first treatment option for relapsed megaesophagus.Resumo -Racional -A melhor opção para o tratamento dos pacientes com megaesôfago e recidiva de sintomas após tratamento prévio sempre foi muito controversa. Em resultados de trabalhos analisados, não há seleção da técnica cirúrgica mais adequada para a doença. Assim, surge a ideia de se realizar um estudo mais seletivo com esofagectomia transmediastinal sem toracotomia em pacientes com megaesôfago avançado recidivado após cardiomiotomia prévia. Objetivo -Avaliar os resultados da esofagectomia transmediastinal no megaesôfago recidivado quanto às complicações sistêmicas e locais. Método -Trinta e dois pacientes foram atendidos todos com recidiva de sintomas após operação prévia e indicação para esofagectomia transmediastinal com transposição gástrica pelo mediastino posterior por apresentarem megaesôfago grau IV.

“…Since the invention of the linear stapling device, this method has become widely used once it was demonstrated to be secure and precise over different segments of the gastrointestinal tract 4,5 . This kind of technique minimizes the development of complications in the anastomotic line because of the double-stapling inverted feature, which lessens ischemia and tissue necrosis 5 .…”

Section: Introductionmentioning

confidence: 99%

Avaliação da terapêutica cirúrgica do divertículo faringoesofágico pela sutura mecânica

Aquino¹,

Said²,

Chagas³

et al. 2012

Self Cite