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At least 19 recordsLinked to original sources
PubMed2005

Prospective non-randomized trial comparing esophagectomy-followed-by-chemoradiotherapy versus chemoradiotherapy-followed-by-esophagectomy for T4 esophageal cancers.

BACKGROUND AND OBJECTIVES: Multimodal treatment is commonly adopted for patients with a T4 esophageal cancer. This trial evaluated which therapy offered a better survival: preoperative chemoradiotherapy (CRT) or postoperative CRT. METHODS: Forty-three patients with a T4 esophageal cancer were enrolled in a prospective study in which each patient decided for themselves a treatment arm, CRT-followed-by-esophagectomy or esophagectomy-followed-by-CRT. The CRT-followed-by-esophagectomy Group received 36 Gy radiotherapy and simultaneous chemotherapy using cisplatin (CDDP) and 5-fluorouracil (5FU) preoperatively, and then 24 Gy radiotherapy and simultaneous chemotherapy using CDDP and 5FU postoperatively. The esophagectomy-followed-by-CRT Group received 60 Gy radiotherapy with two cycles of simultaneous chemotherapy using CDDP and 5FU postoperatively. RESULTS: Of 26 patients who chose CRT-followed-by-esophagectomy, 15 (58%) underwent esophagectomy, while 7 (27%) refused surgery and 4 (15%) were inoperable. Of 17 patients who chose esophagectomy-followed-by-CRT, 14 (82%) underwent esophagectomy, while 3 (18%) underwent inspection thoracotomy. The CRT-followed-by-esophagectomy Group showed a significantly better 5-year-survival rate than the esophagectomy-followed-by-CRT Group (26% vs. 0%). Multivariate analysis demonstrated that only the response to CRT was prognostic. CONCLUSIONS: This trial concluded that the first choice of treatment for patients with a T4 esophageal cancer was prior CRT rather than prior esophagectomy.

Aged↗
PubMed2000

Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy.

HYPOTHESIS: Minimally invasive esophagectomy can be performed as safely as conventional esophagectomy and has distinct perioperative outcome advantages. DESIGN: A retrospective comparison of 3 methods of esophagectomy: minimally invasive, transthoracic, and blunt transhiatal. SETTING: University medical center. PATIENTS: Eighteen consecutive patients underwent combined thoracoscopic and laparoscopic esophagectomy from October 9, 1998, through January 19, 2000. These patients were compared with 16 patients who underwent transthoracic esophagectomy and 20 patients who underwent blunt transhiatal esophagectomy from June 1, 1993, through August 5, 1998. MAIN OUTCOME MEASURES: Operative time, amount of blood loss, number of operative transfusions, length of intensive care and hospital stays, complications, and mortality. RESULTS: Patients who had minimally invasive esophagectomy had shorter operative times, less blood loss, fewer transfusions, and shortened intensive care unit and hospital courses than patients who underwent transthoracic or blunt transhiatal esophagectomy. There was no significant difference in the incidence of anastomotic leak or respiratory complications among the 3 groups. CONCLUSION: Minimally invasive esophagectomy is safe and provides clinical advantages compared with transthoracic and blunt transhiatal esophagectomy.

Aged↗
PubMed1999

Total esophagectomy versus proximal esophagectomy for esophageal cancer at the cervicothoracic junction.

To investigate the adequate extent of esophagectomy and lymphadenectomy for an esophageal cancer localized at the cervicothoracic junction, the mortality and morbidity rates, survival rates, and patterns of recurrence were retrospectively analyzed in two groups-14 patients who underwent total esophagectomy with or without laryngectomy and 15 patients who underwent proximal esophagectomy with or without laryngectomy-at Kurume University Hospital from 1981 to 1996. Proximal esophagectomy with or without laryngectomy resulted in a lower hospital mortality rate and better overall survival for patients who underwent curative esophagectomy compared with total esophagectomy with or without laryngectomy. Multivariate analysis indicated that the extent of esophagectomy (total esophagectomy versus proximal esophagectomy) was not a prognostic factor. The incidence of recurrence was not different between the two groups. Lymph node metastasis or recurrence from such esophageal cancers was localized to the neck and upper mediastinum. For an esophageal cancer localized at the cervicothoracic junction, therefore, proximal esophagectomy with or without laryngectomy and with cervical and upper mediastinal lymphadenectomy could be better indicated for preselected patients.

Aged↗
PubMed2006

Effectiveness of radical en-bloc-esophagectomy compared to transhiatal esophagectomy in squamous cell cancer of the esophagus is influenced by nodal micrometastases.

PURPOSE: The appropriate surgery for curable squamous cell cancer (SCC) of the esophagus is discussed controversially. PATIENTS AND METHODS: Transthoracic esophagectomy (TTE) with radical en-bloc-lymphadenectomy was performed in 79/120 patients (66%). Due to severe comorbidity, 41/120 patients (34%) underwent less traumatizing transhiatal esophagectomy. Lymph nodes were stained using mAb BER-Ep4. RESULTS: pN0 status was found in 54 patients (45%) and pN1 status in 66 patients (55%). In the pN0 subgroup, 30 out of 54 patients (55.6%) had occult tumor cells in lymph nodes detected with BER-Ep4. pN1 patients had additional BER-Ep4 positive cells in histopathologically negative lymph nodes in 41 out of 66 patients (59.2%). Median disease-specific survival was 31.4 and 16.8 months for the transthoracic and transhiatal groups, respectively (P = 0.129). pN0 patients lived longer after transthoracic resection (P = 0.0349), and in the subgroup without lymph node micrometastases this effect was even stronger (P = 0.025). In contrast, in pN0 patients with nodal microinvolvement, TTE did not entail a survival benefit when compared with the transhiatal group (P = 0.333). CONCLUSION: TTE results in improved outcome in the absence of lymph node micrometastases. Poor survival in patients with lymphatic micro-dissemination indicates systemic disease and the need for adjuvant treatment.

Adult↗
PubMed2006

Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival.

BACKGROUND: Surgical treatment of esophageal cancer is associated with a high rate of morbidity and mortality even in specialized centers. Minimally invasive surgery has been proposed to decrease these complications. METHODS: The authors present their results regarding postoperative complications and the survival rate at 3 years, comparing the classic open procedures (transthoracic or transhiatal esophagectomy) with minimally invasive surgery. Surgical procedures were performed according to procedures published elsewhere. RESULTS: The study enrolled 166 patients who underwent surgery between 1990 and 2003. Open transthoracic surgery was performed for 60 patients. In this group of patients, postoperative mortality was observed in 11% of the cases. Major, minor, and late complications were observed in 61.6% of the patients, and the 3-year survival rate was 30% for this group. Open transhiatal surgery was performed for 59 patients. The morbidity, mortality, and 3-year rate were almost the same as for the transthoracic surgery group. For the 47 patients submitted to minimally invasive procedures (thoracoscopic and laparoscopic), the complications and mortality rates were significantly reduced (38.2% and 6.4%, respectively). For the patients submitted to minimally invasive surgery, the 3-year survival rate was 45.4%. It is important to clarify that the patients submitted to minimally invasive surgery manifested early stages of the diseases, and that this the reason why the morbimortality and survival rates were better. CONCLUSIONS: The transthoracic and transhiatal open approaches have similar early and late results. Minimally invasive surgery is an option for patients with esophageal carcinoma, with reported results similar to those for open surgery. This approach is indicated mainly for selected patients with early stages of the disease.

Adenocarcinoma↗
PubMed1998

[Late morbidity after esophagectomy for cancer: is partial esophagectomy preferred?].

PURPOSE: The aim of this study is to report late postoperative complications occurring after oesophagectomy for cancer over a 12-month period and to compare the incidence of these complications according to the level of the anastomosis. PATIENTS AND METHOD: This study included 106 consecutive patients 51% with subtotal oesophagectomy (thoracic anastomosis), and 49% with total oesophagectomy (cervical anastomosis). The two groups were comparable for age, mean weight loss before surgery, life expectancy, number of positive margins, TNM grading, size and tumour differentiation. RESULTS: Late morbidity concerned 67.9% of the 106 patients. Predominant complications were dysphagia (32.1% of the 106), gastro-esophageal reflux (25.5% of the 106), and diarrhoea (18.8% of the 106). Among all the factors causing dysphagia, evaluated by logistic regression, the level of anastomosis was only found significant with a 20.4% occurrence for thoracic anastomosis and 44.2% for cervical anastomosis (P = 0.012). All the other complications were similar in the two groups. CONCLUSION: Functional results of oesophagectomy for cancer are poor. As partial oesophagectomy morbidity is lower, total oesophagectomy should not be proposed in all cases of oesophageal cancer.

Adult↗
PubMed2003

Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients.

OBJECTIVE: Debate continues as to whether transhiatal esophagectomy results in lower morbidity and mortality than transthoracic esophagectomy. Most data addressing this issue are derived from single-institution studies. To investigate this question from a nationwide multicenter perspective, we used the Veterans Administration National Surgical Quality Improvement Program to prospectively analyze risk factors for morbidity and mortality in patients undergoing transthoracic esophagectomy or transhiatal esophagectomy from 1991 to 2000. METHODS: Univariate and multivariate analyses were performed on 945 patients (mean age, 63 +/- 10 years). There were 562 transthoracic esophagectomies and 383 transhiatal esophagectomies in 105 hospitals, with complete 30-day outcomes recorded. RESULTS: There were no differences in recorded preoperative variables between the groups that might bias any comparisons. Overall mortality was 10.0% (56/562) for transthoracic esophagectomy and 9.9% (38/383) for transhiatal esophagectomy (P =.983). Morbidity occurred in 47% (266/562) of patients after transthoracic esophagectomy and in 49% (188/383) of patients after transhiatal esophagectomy (P =.596). Risk factors for mortality common to both groups included a serum albumin value of less than 3.5 g/dL, age greater than 65 years, and blood transfusion of greater than 4 units (P <.05). When comparing transthoracic esophagectomy with transhiatal esophagectomy, there was no difference in the incidence of respiratory failure, renal failure, bleeding, infection, sepsis, anastomotic complications, or mediastinitis. Wound dehiscence occurred in 5% (18/383) of patients undergoing transhiatal esophagectomy and only 2% (12/562) of patients undergoing transthoracic esophagectomy (P =.036). CONCLUSIONS: These data demonstrate no significant differences in preoperative variables and postoperative mortality or morbidity between transthoracic esophagectomy and transhiatal esophagectomy on the basis of a 10-year, prospective, multi-institutional, nationwide study.

Coma↗
PubMed1993

Transhiatal versus transthoracic esophagectomy for esophageal cancer.

We retrospectively analyzed 238 patients with esophageal carcinoma treated between 1983 and 1991; 120 underwent transthoracic esophagectomy, and 118 underwent transhiatal esophagectomy. The two groups were statistically similar in preoperative characteristics, except that upper esophageal cancer was more frequent in the transhiatal esophagectomy group than in the transthoracic esophagectomy group (p < 0.01). The rate of postoperative complications differed significantly in wound infection (21% in patients who underwent transthoracic esophagectomy, 10% in those who underwent transhiatal esophagectomy; p < 0.05) and empyema (11% with transthoracic esophagectomy, 1% with transhiatal esophagectomy; p < 0.01). Pneumothorax was detected in 24% of the transhiatal esophagectomy cases. Intraoperative blood loss was 1340 +/- 490 ml in the transthoracic esophagectomy group and 930 +/- 340 ml in the transhiatal esophagectomy group (p < 0.001). Hospital mortality was 11% in the transthoracic esophagectomy group and 6.7% in the transhiatal esophagectomy group. Late complication rate was lower with transhiatal esophagectomy than with transthoracic esophagectomy (11% and 51%, respectively). There was no significant difference in actuarial survival of patients in both groups. Transhiatal esophagectomy, which can be performed in almost all levels of the esophagus, is the safer of the two operations.

Anastomosis, Surgical↗
PubMed1994

Comparison of three techniques of esophagectomy within a residency training program.

Residency training programs commonly emphasize a single technique of esophagectomy, as the safety and the efficacy of teaching or performing more than one type of esophagectomy are unclear. Between 1986 and 1992, 248 patients were explored for possible esophageal resection. Thoracic surgical residents or fellows performed major components of all resections. Two hundred twenty-one patients (adenocarcinoma, 146; squamous cell carcinoma, 72; and other, 3) underwent transthoracic esophagectomy (n = 134), transhiatal esophagectomy (n = 42), or total thoracic esophagectomy (n = 45), a resectability rate of 89.1% (221/248). Complications occurred in 75% of patients with transthoracic esophagectomy, in 69% with transhiatal esophagectomy, and in 80% with total thoracic esophagectomy. The overall operative mortality rate was 6.8% (15/221). Patients with a cervical anastomosis had a higher leak rate (13%) than those with an intrathoracic anastomosis (6%). Median survival was 22 months (19% 5-year survival) and did not differ by operation type or stage. No patient with unresectable disease (n = 27) survived longer than 10 months. Survival for patients with adenocarcinoma stages 3 and 2a suggested a trend toward improved survival after transthoracic esophagectomy despite similar rates of local and distant recurrence. Transthoracic esophagectomy, transhiatal esophagectomy, and total thoracic esophagectomy performed within a residency training program have similar morbidity, mortality, and recurrence rates as those in other modern series. A specific technique of esophagectomy can be selected for individual patients. Survival and sites of recurrence primarily reflect disease stage, not the technique of esophagectomy used.

Adenocarcinoma↗
PubMed2004

Increased risk of cholelithiasis after esophagectomy.

BACKGROUND/PURPOSE: Truncal vagotomy enhances gallstone formation. As esophagectomy involves truncal vagotomy, it was hypothesized that esophagectomy would increase the risk of cholelithiasis. This study was intended to test this hypothesis and to elucidate factors influencing the incidence of cholelithiasis after esophagectomy. METHODS: The study was a retrospective analysis of 136 patients with esophageal carcinoma who had survived for 5 years or longer after esophagectomy. Eight patients (5.9%) had cholelithiasis before esophagectomy. Of the remaining 128 patients, 113 underwent abdominal ultrasonographic examination for cholelithiasis twice a year after esophagectomy; the median follow-up time was 89.5 months (range, 60-117 months). RESULTS: Gallstones developed in 26 (23%) of the 113 patients undergoing regular ultrasonographic examination. The cumulative incidence of cholelithiasis reached a plateau of 34% at 10 years after esophagectomy. Reduction of body mass index after esophagectomy was the strongest independent predictor of gallstone formation after esophagectomy ( P = 0.0001, log-rank test; P = 0.0003, Cox's proportional hazards model). The prevalence of cholelithiasis at 5 years after esophagectomy (18/113; 16%) was significantly higher than that before esophagectomy (8/136; 5.9%; P = 0.012, Fisher's exact test). CONCLUSIONS: Esophagectomy yields an increased risk of the development of cholelithiasis. Truncal vagotomy and postsurgical malnutrition may contribute to this increased gallstone formation after esophagectomy.

Body Mass Index↗
PubMed1992

Transhiatal esophagectomy: a safe alternative for selected patients.

One hundred one consecutive patients underwent an esophagectomy with gastric interposition for benign and malignant processes from January 1982 through July 1990. Seventy-seven underwent transhiatal esophagectomy and 24, transthoracic esophagectomy. Multivariate analysis was performed comparing the hospitalization experience of the two groups. There was no significant difference found between the mean intraoperative blood loss for transhiatal esophagectomy (770 +/- 105 mL) and that of transthoracic esophagectomy (700 +/- 175 mL). There was a significant difference between operative time, with transhiatal esophagectomy averaging 5.4 hours and transthoracic esophagectomy averaging 7.3 hours. Postoperative stay was not significantly different although there was a wide range of values for the transthoracic esophagectomy group. An 8% operative mortality was experienced by both groups. There were a significant number of minor anastomotic leaks at the cervical anastomotic level for the transhiatal esophagectomy group, but all responded to nonoperative management. The highest morbidity and mortality were seen in the subgroup of transhiatal esophagectomies done for laryngocervical malignancies. The lowest morbidity and mortality were seen in the subgroup of 12 patients who underwent transhiatal esophagectomy for nonmalignant esophageal conditions. Transhiatal esophagectomy appears to be a safe alternative for early intrathoracic esophageal malignancies at any level, for bulky distal esophageal lesions, and for benign conditions requiring total esophagectomy.

Blood Loss, Surgical↗
PubMed2001

Local recurrence after total or subtotal esophagectomy for esophageal cancer.

Cancer recurrence is a common problem after esophagectomy for esophageal cancer. Local recurrence is especially problematic because it often negates the palliative benefit of esophagectomy. We conducted a retrospective review to assess the effect of extent of esophageal resection (subtotal or total esophagectomy) on local cancer recurrence. Seventy-four consecutive patients with esophageal cancer underwent esophagectomy at our institution over a four-year period. Their charts were reviewed retrospectively and data was collected on age, gender, histology, stage, tumor location, operation, resection margin status, anastomotic leaks, operative mortality, adjuvant therapy, cancer survival, and local recurrence. Total esophagectomy was done in 19 patients (transhiatal - 3; McKeown - 16) and subtotal esophagectomy was done in the other 55 patients (Lewis - 25; left thoracoabdominal - 30). The two groups were similar with respect to age, gender, histology, stage, anastomotic leaks, operative mortality, adjuvant therapy, and overall survival. Resection margins were positive for residual tumor in 2 out of 19 (11%) total esophagectomies and 9 out of 55 (16%) subtotal esophagectomies (p=0.42). Local recurrence occurred in 3 of 19 (16%) patients treated with total esophagectomy and 23 out of 55 (42%) patients treated with subtotal esophagectomy (p=0.04). We conclude that total esophagectomy is associated with fewer local cancer recurrences than subtotal esophagectomy. We, therefore, recommend total esophagectomy for the surgical treatment of esophageal cancer.

Adenocarcinoma↗
PubMed2001

Optimum treatment strategy for superficial esophageal cancer: endoscopic mucosal resection versus radical esophagectomy.

This study was designed to determine the optimum treatment for a superficial esophageal cancer involving the mucosal or submucosal layer of the esophagus. The subjects were 150 patients with a superficial esophageal cancer who underwent endoscopic mucosal resection (EMR) or esophagectomy in Kurume University Hospital from 1981 to 1997. The mortality and morbidity rates, survival rate, and recurrence rate were retrospectively compared for (1) 35 patients who underwent EMR and 37 patients who underwent esophagectomy for a mucosal esophageal cancer and (2) 45 patients who underwent extended radical esophagectomy and 33 patients who underwent less radical esophagectomy for a submucosal esophageal cancer. Among the 72 patients with a mucosal cancer, lymph node metastasis/recurrence was observed in only one (1%); whereas of 78 patients with a submucosal cancer it was observed in 30 (38%). Among patients with a mucosal cancer the mortality and morbidity rates after EMR were lower than for those after esophagectomy. The survival rate after EMR was the same as that after esophagectomy. No recurrence was observed after either treatment modality. Among the patients with a submucosal cancer, the survival rate was higher and the recurrence rate lower after extended radical esophagectomy; than after less radical esophagectomy; the mortality and morbidity rates after extended radical esophagectomy were the same as those after less radical esophagectomy. Multivariate analysis demonstrated that the treatment modality (EMR versus esophagectomy) did not influence the survival of patients with a mucosal esophageal cancer, whereas it strongly influenced the survival of patients with a submucosal esophageal cancer. We concluded that EMR was the mainstay of treatment for a mucosal esophageal cancer, and extended radical esophagectomy was the mainstay of treatment for a submucosal esophageal cancer.

Aged↗
PubMed2003

Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures.

BACKGROUND: Transhiatal and transthoracic esophagectomy are common approaches for esophageal resection. The literature is limited regarding the combined thoracoscopic and laparoscopic approach to esophagectomy. The aim of this study was to evaluate the outcomes of combined thoracoscopic and laparoscopic esophagectomy for the treatment of benign and malignant esophageal disease. STUDY DESIGN: We performed a retrospective chart review of 46 consecutive minimally invasive esophagectomies performed between August 1998 and September 2002. Indications for esophagectomy were carcinoma (n = 38), Barrett's esophagus with high-grade dysplasia (n = 3), and recalcitrant stricture (n = 5). Of 38 patients with carcinoma 23 (61%) had neoadjuvant therapy. The main outcome measures were operative time, blood loss, length of intensive care unit and hospital stay, conversion rate, morbidity, mortality, pathology, disease recurrence, and survival. RESULTS: Approaches to esophagectomy were thoracoscopic and laparoscopic esophagectomy (n = 41), thoracoscopic and laparoscopic Ivor Lewis resection (n = 3), abdominal only laparoscopic esophagogastrectomy (n = 1), and hand-assisted laparoscopic transhiatal esophagectomy (n = 1). Minimally invasive esophagectomy was successfully completed in 45 (97.8%) of 46 patients. The mean operative time was 350 +/- 75 minutes and the mean blood loss was 279 +/- 184 mL. The median length of intensive care unit stay was 2 days and median length of stay was 8 days. Major complications occurred in 17.4% of patients and minor complications occurred in 10.8%. Late complications were seen in 26.1% of patients. The overall mortality was 4.3%. Among the 38 patients who underwent esophagectomy for cancer the 3-year survival was 57%. In a mean followup of 26 months there was no trocar site or neck wound recurrences. CONCLUSIONS: A thoracoscopic and laparoscopic approach to esophagectomy is technically feasible and safe for the treatment of benign and malignant esophageal disease. With a mean followup of 26 months thoracoscopic and laparoscopic esophagectomy appears to be an oncologically acceptable surgical approach for the treatment of esophageal cancer.

Combined Modality Therapy↗
PubMedDate not supplied

A hospital's annual rate of esophagectomy influences the operative mortality rate.

The reported operative mortality rate for esophagectomy for malignancy ranges from 2% to 30%. The goal of this retrospective study was to evaluate the relationship between a hospital's annual rate of esophagectomy for esophageal cancer and the clinical outcome of the operation. Discharge abstracts of 1561 patients who had undergone esophagectomy for malignancy at acute care hospitals in California from 1990 through 1994 were obtained from the Office of Statewide Health Planning and Development. The hospitals were grouped according to the number of esophagectomies performed during the 5-year period, and a mortality rate was calculated for each group. Logistic regression analysis was used to determine the relationship between a hospital's rate of esophagectomy and the mortality rate. Esophageal resections were performed in 273 hospitals. An average of two or fewer resections were performed annually in 88% of hospitals, which accounted for 50% of all patients treated. The mortality rate in hospitals with more than 30 esophagectomies for the 5-year period was 4.8%, compared with 16% for hospitals with fewer than 30 esophagectomies. This could not be accounted for by other health variables affecting the patients' risk for surgery. There was a striking correlation between a hospital's frequency of esophagectomy and the outcome of this operation. The results support the proposition that high-risk general surgical procedures, such as esophagectomy for malignancy, should be restricted to hospitals that can exceed a yearly minimum experience.

Adult↗
PubMed2003

Salvage or planned esophagectomy after chemoradiation therapy for locally advanced esophageal cancer--a review.

Definitive chemoradiation (without esophagectomy) and neoadjuvant chemoradiation followed by planned esophagectomy are commonly used treatments for locally advanced esophageal cancer. These two treatment strategies have similar survival outcomes, so the value of planned esophagectomy is debated. However, persistence or recurrence of local disease is not uncommon after definitive chemoradiation. Salvage esophagectomy for isolated local failures of definitive chemoradiation is an option for selected patients. In this article we review the debate over definitive chemoradiation versus neoadjuvant chemoradiation and surgery, and then restate the argument in terms of salvage versus planned esophagectomy. Although both forms of esophagectomy are done in the setting of previous chemoradiation, they are different in several ways. Salvage esophagectomy appears to be a more morbid operation than planned esophagectomy. Surgeons supportive of the salvage esophagectomy strategy face the challenge of reducing its postoperative mortality.

Combined Modality Therapy↗
PubMed2000

Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer.

OBJECTIVE: We sought to evaluate the effect of operative volume, hospital size, and cancer specialization on morbidity, mortality, and hospital use after esophagectomy for cancer. METHODS: Data derived from the Health Care Utilization Project was used to evaluate all Medicare-reimbursed esophagectomies for treatment of cancer from 1994 to 1996 in 13 national cancer institutions and 88 community hospitals. The complications of care, length of stay, hospital charges, and mortality were assessed according to hospital size (>/=600 beds vs <600 beds), cancer specialization (national cancer institution vs community hospital), and operative volume (esophageal [>/=5 Medicare esophagectomies per year vs <5 Medicare esophagectomies per year] and nonesophageal operations [>/=3333 cases per year vs <3333 cases per year]). RESULTS: Mortality was lower in national cancer institution hospitals (4.2% [confidence interval, 2.0%-6.4%] vs 13.3% [confidence interval, 4.2%-26.2%], P =. 05) and in hospitals performing a large number of esophagectomies (3. 0% [confidence interval, 0.09%-5.1%] vs 12.2% [confidence interval, 4.5%-19.8%], P <.05). Multivariate analysis revealed that the independent risk factor for operative mortality was the volume of esophagectomies performed (odds ratio, 3.97; P =.03) and not the number of nonesophageal operations, hospital size, or cancer specialization. Hospitals performing a large number of esophagectomies also showed a tendency toward decreased complications (55% vs 68%, P =.06), decreased length of stay (14.7 days vs 17.7 days, P =.006), and decreased charges ($39,867 vs $62, 094, P <.005). CONCLUSIONS: These results demonstrate improved outcomes and decreased hospital use in hospitals that perform a large number of esophagectomies and support the concept of tertiary referral centers for such complex oncologic procedures as esophagectomies.

Aged↗
PubMed1997

[Video-assisted esophagectomy for carcinoma of the esophagus, using thoracoscopy or mediastinoscopy].

To reduce the high morbidity rate associated with esophagectomy for esophageal cancer, thoracoscopic approach has been recently introduced. However thoracoscopic esophagectomy has been performed as a palliative operation like the transhiatal esophagectomy. We have developed a technique of video-assisted thoracic surgery (VATS) using thoracoscopy or mediastinoscopy as a radical esophagectomy. For the extensive lymph node dissection, especially along bilateral recurrent nerves, could be successfully performed in more than 20 patients by VATS with thoracoscopic instruments through the usual thoracotomy. And we have also applied VATS with small thoracotomy to the radical esophagectomy. Using this technique, we could performed esophagectomy almost same as the radical esophagectomy through usual thoracotomy even in small number of cases. Furthermore, disadvantages of the transhiatal esophagectomy, inherent in the blind dissection involved, was almost conquered by VATS using mediastinoscopy. These initial results of ours indicate that video-assisted esophagectomy is a feasible procedure as the radical operation for esophageal cancer.

Endoscopy↗