Novosti
Khirurgii

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Year 2014 Vol. 22 No 4

ONCOLOGY

V.T. MALKEVICH, I.A. ILYIN

THE COMPARATIVE ASSESSMENT OF VARIOUS METHODS OF RECONSTRUCTIVE ESOPHAGOCOLOPLASTY AT ESOPHAGEAL AND GASTROESOPHAGEAL CANCER

SE "N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology "
Ìinsk,
The Republic of Belarus

Objectives. To assess the efficacy of prevention complex of ischemic complications in esophageal reconstruction by esophagocoloplasty in patients with esophageal and gastroesophageal cancer.
Methods. In the Republican Scientific Practical Center of Oncology and Medical Radiology named by N.N. Alexandrov in the department of thoracic oncopathology the delayed esophagocoloplasty has been produced for 41 patients after radical surgeries due to the esophageal and gastroesophageal cancer (primary disconnection and induced disconnection surgeries due to the primary plastic complications) in the period from 2007 to 2013 yrs. This cohort was divided into 2 groups: control (n=21) group and the main (n=20) one.
In the control group the patients have been operated by performing a conventional plasty, in the main group – by applying the developed prevention complex of ischemic complications: graft vascularization by transposition of the mesenteric colon vessels to the internal thoracic vessels, formation of the modified end-to-end esophagus-colon anastomosis, the elimination of osseous (resection of the xiphoid process of the sternum) and muscular (left-sided wide dissection of the anterior straight muscles of the neck) compression factors to the graft in retrosternal tunnel formation.
Results. In analyzing the structure of post-operative surgical complications it was found out that the use of prevention complex of ischemic complications permits to reduce significantly the frequency of postoperative complications in 3,8-folds from 57,1% up to 15% (p=0,006). Thus, the frequency of ischemic complications reduced in 6,6-folds from 33,3% to 5% (p=0,024). Analysis of the logistic regression model shows that the developed prevention complex of ischemic complications reduces reliably (p=0,045) a proportional risk of specific ischemic complications (graft necrosis and/or esophageal-colon anastomotic leakage) in 9,5-folds.
Conclusions. Applying the prevention complex of ischemic complications in delayed esophagocoloplasty performing allows improving of the immediate results of treatment in patients undergoing radical operation for esophageal and gastroesophageal cancer.

Keywords: esophagoplasty, esophagocoloplasty, two-stage operation, esophageal cancer, gastroesophageal cancer
p. 463 – 469 of the original issue
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Address for correspondence:
223040, Respublika Belarus, Minskaya oblast, Minskiy rayon, agrogorodok Lesnoy 2, GU "RNPTs onkologii i meditsinskoy radiologii im. N.N. Aleksandrova", otdel torakalnoy onkopatologii s gruppoy anesteziologii,
e-mail: ileus@tut.by,
Ilin Ilya Anatolevich
Information about the authors:
Malkevich V.T. MD, a chief researcher of the thoracic oncopathology department with the anesthesiology group of SE “N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology”.
Ilyin I.A. A full-time post-graduate student, SE “N.N. Alexandrov Republican Scientific Practical Center of Oncology and Medical Radiology”.
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