This journal is
indexed in Scopus
Year 2015 Vol. 23 No 6
I.A. ILYIN, V.T. MALKEVICH
COMPARATIVE EVALUATION OF DIRECT TREATMENT RESULTS OF ESOPHAGEAL CANCER IN DIFFERENT TYPES OF SURGICAL INTERVENTIONS
SE "N.N. Alexandrov National Cancer Centre of Belarus", Minsk,
The Republic of Belarus
Objectives. To determine an optimal type of surgical treatment of patients suffering from esophageal cancer and to carry out comparative analysis of the main types of surgical procedures.
Methods. From 1990 to 2010 yrs. the radical surgeries in patients (n=347) with esophageal cancer have been performed in the "N.N. Alexandrov National Cancer Centre of Belarus". Three groups of patients were compiled. The 1st group (n=255) – the patients underwent to two-level transthoracic esophagectomy. The 2nd group (n=60) – three-level transthoracic esophagectomy. The 3rd group (n=32) – transhiatal esophagectomy.
Results. In total cohort the post-operative complications were observed in 34,6% of patients. 30-day postoperative mortality was 12,1%, hospital mortality – 13,5% and 60-day one – 15,3%. Cervical esophageal anastomosis leak was dominated in the 2nd and 3rd groups – 21,7% and 18,8%, respectively (p<0,001). The application of a wide gastric pedicle (n=57) with anastomosis in the cervical region the incidence of graft necrosis and anastomotic leak was 19,3%, which was lower in comparison with a narrow gastric pedicle (n=35) where those complications occurred in 48,6% of cases (p=0,006). At the same time hospital mortality was 5,3% and 2,9%, respectively (p=0,982). In esophagoplasty by narrow pedicle stalk (n=53) necrosis developed in 9,3% (p=0,938). 12,5% of the patients out of the 255 patients with localized intrapleural anastomosis died, while in the cervical localization (n=92) mortality was 16,3% (p=0,469).
Conclusion. In the cases of mid- and lower-thoracic esophageal cancer the two-level access to organs of abdominal and pleural cavities with application of intrapleural esophageal anastomosis and three-level access with cervical anastomosis for upper thoracic cancer are considered to be optimal. As for transhiatal access this technique seems to be less traumatic and made similar results with the direct ones of other types of surgical procedures.
- Shah SV, Chheda YP, Pillai SK, Shah SV. Total oesophagectomy for squamous cell carcinoma with or without standard two field node dissection – a prospective study. Indian J Surg Oncol. 2013 Dec; 4(4):336–40. doi: 10.1007/s13193-013-0264-5 PMCID: PMC3890016
- Vijayakumar M, Burrah R, Hari K, Veerendra KV, Krishnamurthy S. Esophagectomy for cancer of the esophagus. A regional cancer centre experience. Indian J Surg Oncol. 2013 Dec; 4(4): 332–335. doi: 10.1007/s13193-013-0260-9 PMCID: PMC3890020
- Wang H, Tan L, Feng M, Zhang Y, Wang Q. Comparison of the short-term health-related quality of life in patients with esophageal cancer with different routes of gastric tube reconstruction after minimally invasive esophagectomy. Quality of Life Research. 2011 March;20(2): 179-89.
- Davydov MI, Stilidi IS. Rak pishchevoda [Esophageal carcinoma]. Moscow, RF: Izdatel'skaia gruppa RONTs. Meditsina; 2007. 392 p.
- Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Annals of Surgery. doi: 10.1097/SLA.0b013e3182263781
- Colvin H, Dunning J, Khan OÀ. Transthoracic versus transhiatal esophagectomy for distal esophageal cancer: which is superior? Thoracic Surgery. 2011;(12):265-69. doi: 10.1510/icvts.2010.252148.
- Wright D, Kucharczuk JC, O’Brien SM, Grab JD, Allen MS. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009;(137)3:587-95. doi: 10.1016/j.jtcvs.2008.11.042.
- Mal'kevich VT, Zharkov VV, Ositrova LI, Kurchin VP, Baranov AIu, Il'in IA. Novye podkhody k lecheniiu vnutriplevral'nykh oslozhnenii v khirurgii raka pishchevoda [New approaches to the treatment of intrapleural complications of surgery for esophageal cancer]. Novosti Khirurgii. 2012;(20)3:74-80.
- Aminian A, Panahi N, Mirsharifi R, Karimian F, Meysamie A, Khorgami Z. Predictors and outcome of cervical anastomotic leakage after esophageal cancer surgery. J Cancer Res Ther. 2011;(7)4:448-53.
- Kassis ES, Kosinski AS, Ross P, Koppes KE, Donahue JM, Daniel VC. Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013 Dec; 96(6):1919-26
- Miroshnikov BI, Gorbunov GN, Ivanov PP. Plastika pishchevoda [Esophagoplasty]. Saint-Petersburg: ELBI-SPb; 2012. 368 p.
- Ott K, Sisic L, Büchler M. Squamous cell carcinoma of the esophagus. Chirurg. 2011;(82)11:974-80.
223040, Republic of Belarus,
Minskaya oblast, Minskiy rayon,
agrogorodok "Lesnoy" 2,
GU "RNPTs onkologii i meditsinskoy radiologii im. N.N. Aleksandrova", khirurgicheskiy otdel,
tel. mob.: 375 44 713-59-56,
Ilyin Ilya Anatolevich
Ilyin I.A. PhD, a senior researcher of the surgical department of SE "N.N. Alexandrov National Cancer Centre of Belarus",
Malkevich V.T. MD, a head of the oncologic thoracic department of SE "N.N. Alexandrov National Cancer Centre of Belarus".