Esophageal cancer − results of surgical treatment at the Department of Surgery I. at the University Hospital Olomouc

Česká verze

Authors: R. Vrba ¹; R. Aujeský ¹; M. Stašek ¹; K. Vomáčková ¹; J. Tesaříková ¹; L. Hlaváčková ¹; J. Cincibuch ²; D. Vrána ²; M. Horáková ³; J. Zapletalová ⁴; Č. Neoral ¹
Authors place of work: I. Chirurgická klinika Lékařské fakulty Univerzity Palackého a Fakultní nemocnice Olomouc ¹; Onkologická klinika Lékařské fakulty Univerzity Palackého a Fakultní nemocnice Olomouc ²; Oddělení IPCHO Fakultní nemocnice Olomouc ³; Katedra biofyziky Lékařské fakulty Univerzity Palackého ⁴
Published in the journal: Rozhl. Chir., 2018, roč. 97, č. 7, s. 342-348.
Category: Původní práce

Summary

The authors present the results of surgical treatment of esophageal cancer at Department of Surgery I, University Hospital Olomouc between 2006−2016. The aim of the study was to use retrospective analysis to evaluate the results of patients operated for esophageal cancer and statistically evaluate the results based on the type of surgical approach (transhiatal, transthoracic).

Method:

A total of 240 patients with esophageal cancer were operated at Department of Surgery I between the beginning of 2006 and the end of 2016. We evaluated respiratory complications, the incidence of anastomotic fistula and complications based on the Clavien-Dindo classification of complications, based on the type of surgical approach selected (transhiatal or transthoracic esophagectomy).

Results:

The patient set included 207 men (86.3%) and 33 women (13.7%). The mean patient age was 60.4 years. The histological type was adenocarcinoma in 145 (60.4%) and squamous cell carcinoma in 90 (37.5%) patients; another type of carcinoma was observed in 5 cases. Transhiatal esophagectomy was performed in 194 patients (80.2%) (transhiatal laparoscopic in 190 and classic Orringer in 4 patients). Transthoracic approach was used in 46 patients (19.2%), thoracoscopic in 16, and thoracotomic in 30 patients. A gastric conduit was used in 236 patients and coloplasty was performed in 4 patients. The mean duration of surgery was 217 min for the transhiatal approach, 239 min for the thoracoscopic approach and 277 min for the thoracotomic approach. Total blood loss per patient was 562 ml on average for all the operated patients. Peri- or postoperative blood transfusions were administered to 148 patients. Lymphadenectomy was performed as part of the procedure in all patients; the mean of 16.1 lymph nodes were removed. The average hospital stay was 20.7 days. In the patient set, 30-day mortality included 12 patients (respiratory complications 10, MI 1, conduit necrosis 1) and 90-day mortality included 4 (multi organ failure during ARDS). Based on statistical analysis, the incidence of respiratory complications significantly correlated with ASA classification (p=0.0001) and Clavien-Dindo classification (p<0.0001). ASA score 3 was significantly more common and ASA score 2 uncommon in patients with severe respiratory complications (respiratory failure, ARDS) compared to patients without respiratory complications. Furthermore, patients with severe complications were significantly more commonly classified as Clavien-Dindo 4 and 5 compared to patients with less severe or no respiratory complications. Based on statistical analysis, we did not observe a significant difference in the rate of respiratory complications between the transhiatal and transthoracic approaches.

Conclusion:

Esophageal cancer is a malignant disease whose curative treatment is surgical esophagectomy. Esophagectomy should unequivocally be performed in specialized centers experienced in the treatment of this serious malignancy (High volume centers) and by knowledgeable oncosurgeons with many years of experience with esophageal surgery.

Key words:

esophageal cancer − transhiatal esophagectomy − transthoracic esophagectomy

Zdroje

1. Kutup A, Nentwich MF, Bollschweiler E, et al. What should be the gold standard for the surgical component in the treatment of locally advanced esophageal cancer: transthoracic versus transhiatal esophagectomy. Ann Surg 2014;260:1016−22.

2. Ninomiya I, Osugi H, Fujimura T, et al. Thoracoscopic esophagectomy with extended lymph node dissection in the left lateral position: technical feasibility and oncologic outcomes. Dis Esophagus 2014;27:159−67.

3. Meng F, Li Y, Ma H, et al. Comparison of outcomes of open and minimally invasive esophagectomy in 183 patients with cancer. J Thorac Dis 2014;6:1218−24.

4. Zhai C, Liu Y, Li W, et al. A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis 2015;7:2352−8.

5. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label,randomised controlled trial. Lancet 2012;379:1887−92.

6. Neoral Č, Král V, Aujeský R. Náhrada jícnu tlustým střevem – zkušenosti se 109 případy. Rozhl chir 2010;12:740−5.

7. Aujeský R, Neoral Č, Král V, et al. Videoasistovaná resekce jícnu pro karcinom – desetileté zkušenosti. Rozhl chir 2010;12:746−50.

8. Smithers B M, Gotley D C, Martin I, et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 2007;245:232−40.

9. Kinjo Y, Kurita N, Nakamura F, et al. Effectiveness of combined thoracoscopic-laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc 2012;26:381−90.

10. Gao Y, Wang Y, Chen L, et al. Comparison of open three-field and minimally-invasive esophagectomy for esophageal cancer. Interact Cardiovasc Thorac Surg 2011;12:366−9.

11. Ursehel JD. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 1995;169:634−40.

12. Udagawa H, Tsutsumi K, Kinoshita Y, et al. Operative technique training at en bloc dissection in esophageal surgery. Niphon Geka Gakkai Zasshi 2005;106:275−9.

13. Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphadenectomy for thoracic esophageal cancer. J Surg Oncol 2012;106:742−66.

14. Chen X, Chen J, Zheng X, et al. Prognostic factors in patients with thoracic esophageal carcinoma staged pT1-4aN0M0 undergone esophagectomy with three-field lymphadenectomy. Ann Transl Med 2015;3:282.

15. Chen J, Pan J, Zheng X, et al. Number and location of positive nodes, postoperative radiotherapy, and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2012;82:475−82.

16. Bollschweiler E, Baldus SE, Schröder W, et al. Staging of esophageal carcinoma: length of tumor and number of involved regional lymph nodes. Are these independent prognostic factors? J Surg Oncol 2006;94:355−63.

17. Ott K, Bader FG, Lordick F, et al. Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patient at an experienced center. Ann Surg Oncol 2009;16:1017−25.

18. Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorax Cardiovasc Surg 2002;123:661−69.

19. Wormuth JK, Heitmiller RF. Esophageal conduit necrosis. Thorac Surg Clin 2006;16:11−22.

20. Ursehel JD, Esophagogastrostomy anastomotic leaks comlicating esophagectomy: a review. Am J Surg 1995;169:634−40.

21. Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy. Annals of Surgery 2015;262:286−94.

22. Buskens CJ, Hulscher JBF, Fockens P, et al. Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy. Ann Thorac Surg 2001;72:221−4.

23. Nardella JE, Van Raemdonck D, Piessevaux H, et al. Gastro-tracheal fistula – unusual and life threatening complication after esophagestomy for cancer: a case report. J Cardiothorac Surg 2009;29:69.

24. Freire JP, Feijo SM, Miranda L, et al. Tracheo-esophageal fistula: combined surgical and endoscopic approach. Dis Esophagus 2006;19:36−9.

25. Atkins BZ, Shan AS, Kelley A, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004;78:1170−6.

26. Nishihira T, Suzuki T, Mori S. A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esofagus. American J Surg 1998;175:47−51.

27. Tapias LF, Morse CR. Minimally invasive Ivor Lewis esophagectomy: description of a learning curve. J Am Coll Surg 2014;218:1130−40.

28. Horaková M, Lubušká L, Kolář K, et al. Individualized prophylaxis in patients with esophageal replacement for cancer. Surgical Infections 2015;16:513−7.

29. Pennathur A, Awais O, Luketich JD. Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 2010;89:S2159−62.

30. Van Daele E, Van de Putte D, Ceelen W, et al. Risk factors and consequences of anastomotic leakage after Ivor Lewis oesophagectomy. Interact Cardiovasc Thorac Surg 2016;22:32−7.