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Article: Analysis of reduced death and complication rates after esophageal resection

TitleAnalysis of reduced death and complication rates after esophageal resection
Authors
Issue Date2001
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2001, v. 233 n. 3, p. 338-344 How to Cite?
AbstractObjective: To identify factors that have contributed to reduced rates of death and complications after esophageal resection in a 17-year period at a tertiary referral center. Summary Background Data: There has been an evolving refinement in surgical technique and perioperative management of patients undergoing esophageal resection at Queen Mary Hospital during the past two decades. As of the end of 1998, there had been no hospital deaths among the last 105 consecutive resections performed for esophageal squamous cancer. Methods: The results of esophageal resection for squamous cell carcinoma were analyzed using a prospective esophageal database. A longitudinal study was performed to compare and analyze rates of death and complications for three consecutive time periods. Results: The study group comprised 710 patients who underwent one-stage esophageal resection between 1982 and 1998. A transthoracic esophagectomy was the preferred approach in 590 patients (83%). The overall hospital death rate was 11%. The leading causes of hospital death were pulmonary complications (45.5%) and progression of malignant disease (21.5%); anastomotic leakage accounted for 9% of deaths. During the study period, the hospital death rate decreased from 16% to 3.2%, and the incidence of postoperative respiratory failure decreased from 15.5% to 6.5%. Perioperative factors that correlated with the decreased death rate over time were the increased postoperative use of epidural analgesia and bronchoscopy (for clearance of pulmonary secretions), a decrease in history of smoking, and a decrease in surgical blood loss of more than 1,000 mL. Conclusions: In this series of predominantly transthoracic esophagectomies, there has been a decline in the hospital death rate to less than 5%. These results are largely attributable to factors aimed at reducing postoperative pulmonary complications.
Persistent Identifierhttp://hdl.handle.net/10722/49333
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWhooley, BPen_HK
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorMurthy, SCen_HK
dc.contributor.authorAlexandrou, Aen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2008-06-12T06:39:42Z-
dc.date.available2008-06-12T06:39:42Z-
dc.date.issued2001en_HK
dc.identifier.citationAnnals Of Surgery, 2001, v. 233 n. 3, p. 338-344en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49333-
dc.description.abstractObjective: To identify factors that have contributed to reduced rates of death and complications after esophageal resection in a 17-year period at a tertiary referral center. Summary Background Data: There has been an evolving refinement in surgical technique and perioperative management of patients undergoing esophageal resection at Queen Mary Hospital during the past two decades. As of the end of 1998, there had been no hospital deaths among the last 105 consecutive resections performed for esophageal squamous cancer. Methods: The results of esophageal resection for squamous cell carcinoma were analyzed using a prospective esophageal database. A longitudinal study was performed to compare and analyze rates of death and complications for three consecutive time periods. Results: The study group comprised 710 patients who underwent one-stage esophageal resection between 1982 and 1998. A transthoracic esophagectomy was the preferred approach in 590 patients (83%). The overall hospital death rate was 11%. The leading causes of hospital death were pulmonary complications (45.5%) and progression of malignant disease (21.5%); anastomotic leakage accounted for 9% of deaths. During the study period, the hospital death rate decreased from 16% to 3.2%, and the incidence of postoperative respiratory failure decreased from 15.5% to 6.5%. Perioperative factors that correlated with the decreased death rate over time were the increased postoperative use of epidural analgesia and bronchoscopy (for clearance of pulmonary secretions), a decrease in history of smoking, and a decrease in surgical blood loss of more than 1,000 mL. Conclusions: In this series of predominantly transthoracic esophagectomies, there has been a decline in the hospital death rate to less than 5%. These results are largely attributable to factors aimed at reducing postoperative pulmonary complications.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshCarcinoma, Squamous Cell - mortality - surgeryen_HK
dc.subject.meshEsophageal Neoplasms - mortality - surgeryen_HK
dc.subject.meshEsophagectomy - mortalityen_HK
dc.subject.meshPostoperative Complications - epidemiologyen_HK
dc.subject.meshAnalgesia, Epiduralen_HK
dc.titleAnalysis of reduced death and complication rates after esophageal resectionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=233&issue=3&spage=338&epage=344&date=2001&atitle=Analysis+of+reduced+death+and+complication+rates+after+esophageal+resectionen_HK
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1097/00000658-200103000-00006en_HK
dc.identifier.pmid11224620-
dc.identifier.pmcidPMC1421248en_HK
dc.identifier.scopuseid_2-s2.0-0035118867en_HK
dc.identifier.hkuros60502-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0035118867&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume233en_HK
dc.identifier.issue3en_HK
dc.identifier.spage338en_HK
dc.identifier.epage344en_HK
dc.identifier.isiWOS:000167250200006-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridWhooley, BP=6602989930en_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridMurthy, SC=7202013138en_HK
dc.identifier.scopusauthoridAlexandrou, A=12760653800en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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