Novosti
Khirurgii

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Year 2015 Vol. 23 No 6

ONCOLOGY

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.

Keywords: esophageal cancer, two-level esophageal resection, three-level transthoracic esophagectomy, transhiatal esophagectomy, cervical anastomosis, necrosis, anastomotic failure
p. 658-665 of the original issue
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Address for correspondence:
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,
e-mail: ileus@tut.by,
Ilyin Ilya Anatolevich
Information about the authors:
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".
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