Wie sicher ist die hoch intrathorakale Ösophagogastrostomie?

Abstract

The surgical results of transthoracic en bloc esophagectomy and high intrathoracic esophagogastrostomy performed on 109 consecutive patients are presented. Adenocarcinoma was present in 59 patients, squamous cell carcinoma in 45 patients, and other neoplastic lesions of the esophagus in 5 patients: 29.5% of the patients received neoadjuvant radiochemotherapy or chemotherapy alone. In 35% of the patients, the preoperative risk was classified as normal, whereas in 42% and 23% of the patients the preoperative status was compromised or severely impaired, respectively. On average 33 lymph nodes were dissected from each specimen. The postoperative course was uneventful in 60% of the patients and prolonged or severe in 40% of the patients. The hospital mortality was 5.5% (six patients). Nine patients (8.2%) developed anastomotic leakage. Six of these nine patients were discharged after rethoracotomy and reanastomosis ( n=3) or endoscopic treatment with fibrin glue ( n=3). Three patients died despite rethoracotomy and reanastomosis. Only 2 of 103 discharged patients (1.9%) underwent postoperative endoscopic bougienage two or three times because of an anastomotic stenosis. High intrathoracic esophagogastrostomy is a safe anastomosis, which nevertheless requires diligent postoperative management.

High-Volume Centers – Effect of Case Load on Outcome in Cancer Surgery

“…The median value halved again to 3.5% for esophageal resections performed in hospitals operating on more than 20 cases per year. This literature analysis confirms the described trend from the individual studies with a clear correlation between case volume and post-operative mortality rate [2,11,16,22,25,26]. Dimick et al [25] and Patti et al [16] investigated the cause for this correlation, and came to the following conclusions: Dimick and colleagues showed that the complications after esophagectomy in high-volume centers in all 6 investigated categories were significantly less severe than those in the low-volume centers [25].…”

“…[9,15,16,18,27,28]. Evidence from the few evaluations available in the literature indicates that about 20 or more esophagectomies per year per institution are necessary to promise a high probability of decreased post-operative mortality and a better long-term prognosis [26].…”

Staging of esophageal carcinoma: Length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors?

“…Standard reconstruction for patients receiving transthoracic esophagectomy was done by stomach interposition with high intrathoracic esophagogastrostomy [10]. Two patients underwent esophagogastrectomy, and five patients underwent cervical esophagus resection with jejunal interposition.…”

Chirurgie des Barrett-Adenokarzinoms

“…Bei Karzinomen oberhalb der Trachealbifurkation ist jedoch die zervikale Ösopha-gusdurchtrennung und Anastomose zu fordern, damit eine R0-Resektion mit ausreichendem Sicherheitsabstand erzielt werden kann. Die hoch intrathorakale Ösophagogastrostomie weist bei gleicher postoperativer Letalität eine geringere Insuffizienzrate und bessere Schluckfunktion der Patienten als die zervikale Anastomose auf [2]. Durch die höhere Leckagerate entstehen bei zervikalen Anastomosen häufiger Strikturen, sodass oft postoperative Bougierungen notwendig sind.…”