Medina H, Cortés R, Ramos GG, Quezada C, Flores C, Orozco H

Language: Spanish
References: 12
Page: 87-90
PDF size: 38.26 Kb.

ABSTRACT

Objective: To analyze the morbidity and mortality of transhiatal esophagectomy in a third level health care hospital.
Setting: National Institute of Medical Sciences and Nutrition “Salvador Zubirán”.
Design: Descriptive, comparative, retrospective study.
Statistical analysis: Student’s t test to compare means and chi square test for nominal variables.
Material and methods: We reviewed the clinical records of patients subjected to transhiatal esophagectomy in the last 20 years. Analyzed variables were: preoperative state, demographic data, indications and complications. The study period was divided in two; the first from 1984 to 1999, managed by different medical teams, and the second from 1999 to 2005 operated by the same medical team.
Results: We analyzed 114 transhiatal esophagectomies. Average age of patients was 45.96 years (12 to 79 years); 72 men (63.2%) and 42 women (36.8%). Indications for the procedure were in 52 (46.6%) patients due to cancer and in 62 (54.3%) benign causes. In 92 (80.7%) patients the transhiatal esophagectomy was performed with gastric pull-up and in 22 (19.29%) patients with colonic pull-up. Operative mortality was of 9.62% (11 cases). Transoperative complications were encountered in 14 (12.3%) patients. Morbidity during the postoperative period was of 38.7% (44 patients). From 1999 on, morbidity decreased to 21.3%, and mortality decreased to 3.2% (p = 0.001). Fistula of the anastomosis occurred in 21 patients, and were treated conservatively. Follow-up of patients in the outpatient service was in average of 2.6 years. Stenosis of the anastomosis occurred in 36.8% (42 patients) and was resolved with dilations.
Conclusions: Transhiatal esophagectomy is an option for the treatment of malignant and benign diseases of the esophagus, The most frequent complications are leaks of the esophagogastric anastomosis and stenosis. Mortality is markedly reduced when the procedure is performed by specialized personnel.

REFERENCES

1. Orringer MB, Sloan H. Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg 1978; 76: 643-54.

2. Akiyama H, Sato Y, Takashashi F. Immediate pharigogastrostomy following total esophagectomy by blunt dissection. Jpn J Surg 1971; 1: 225-331.

3. Maish MS, DeMeester SR. Indication and technique of colon and jejunal interpositions for esophageal disease. Surg Clin North Am 2005; 85: 505-514.

4. Thomas P, Fuentes P, Giudicelli R, Reboud E. Colon interposition for esophageal replacement: current indications and long term function. Ann Thorac Surg 1997; 64: 757-64.

5. Cortés González R. Avances en el tratamiento quirúrgico del cáncer del esófago. Rev Gastroenterol Mex 1992; 57: 90-94.

6. Orringer MB. Transhiatal esophagectomy for benign disease. J Thorac Cardiovasc Surg 1985; 90: 649-55.

7. Briel JW, Tamhankar AP, Hagen JA, DeMeester SR, Johansson J, Choustoulakis E, et al. Prevalence and risk factors for ischemia, leak and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 2004; 198: 536-41.

8. Honkoop P, Siersema PD, Tilanus HW, Stassen CP, Hop WC, van Blankenstein M. Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 1996; 111: 1141-8.

9. Cassivi SD. Leaks, strictures and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg 2004; 16: 124-32.

10. Orringer MB. Technical aids in performing transhiatal esophagectomy without thoracotomy. Ann Thorac Surg 1984; 38: 128-32.

11. DeMeester TR, Peters HJ. Surgical therapy for cancer of the esophagus and cardia En: Castell, DO, Ricther J (eds). The Esophagus. 3rd edition. Philadelphia Lippincott Williams & Willkins, 1999: 259-290.

12. Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Principles of surgical treatment for carcinoma of the esophagus: analysis of lymph node involvement. Ann Surg 1981; 194: 438-46.