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Article: The Kirschner operation in unresectable esophageal cancer: Current application

TitleThe Kirschner operation in unresectable esophageal cancer: Current application
Authors
Issue Date2002
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 2002, v. 137 n. 11, p. 1228-1232 How to Cite?
AbstractHypothesis: With the introduction of safe, effective nonoperative alternatives, bypass surgery for unresectable esophageal cancer is infrequently performed, but it has a limited role in palliation of esophageal cancer that needs to be defined. Design: Retrospective cohort study. Setting: Department of Surgery at Queen Mary Hospital in Hong Kong. Patients: Patients who had unresectable esophageal cancer and underwent bypass surgery between January 1, 1991, and December 31, 1998. Intervention: Bypass procedures were performed using a gastric or colonic conduit to the neck. Main Outcome Measures: Morbidity and mortality and quality of palliation. Results: Thirty-eight patients underwent retrosternal bypass to the neck using a gastric (n = 27) or colonic (n = 11) conduit. Ten patients (26%) underwent unplanned bypass at the time of exploration for resection because of unexpected findings of T4 disease (n = 2) or technical difficulties in addition to advanced disease (n = 8). Between 1991 and 1994, 1 of 26 bypasses was unplanned and the hospital mortality was 42% (11/26), while between 1995 and 1998, 9 of 12 bypasses were unplanned and the hospital mortality was 8% (1/12). There were 12 hospital deaths in the planned bypass group (n = 28) and none in the unplanned bypass (n = 10) group (43% vs 0%, P = .01). The median survival in patients who underwent unplanned bypass was 6.9 months, compared with 1.9 months in patients who underwent planned bypass (P = .004). All patients were discharged from the hospital on at least a semisolid diet. Conclusions: The Kirschner operation is largely obsolete as a planned procedure because of high morbidity and mortality. Bypass surgery, however, is a reasonable option as an unplanned procedure when resection is precluded at the time of exploration because of unexpected adverse operative findings.
Persistent Identifierhttp://hdl.handle.net/10722/83681
ISSN
2014 Impact Factor: 4.926
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.authorChu, KMen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:43:56Z-
dc.date.available2010-09-06T08:43:56Z-
dc.date.issued2002en_HK
dc.identifier.citationArchives Of Surgery, 2002, v. 137 n. 11, p. 1228-1232en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/83681-
dc.description.abstractHypothesis: With the introduction of safe, effective nonoperative alternatives, bypass surgery for unresectable esophageal cancer is infrequently performed, but it has a limited role in palliation of esophageal cancer that needs to be defined. Design: Retrospective cohort study. Setting: Department of Surgery at Queen Mary Hospital in Hong Kong. Patients: Patients who had unresectable esophageal cancer and underwent bypass surgery between January 1, 1991, and December 31, 1998. Intervention: Bypass procedures were performed using a gastric or colonic conduit to the neck. Main Outcome Measures: Morbidity and mortality and quality of palliation. Results: Thirty-eight patients underwent retrosternal bypass to the neck using a gastric (n = 27) or colonic (n = 11) conduit. Ten patients (26%) underwent unplanned bypass at the time of exploration for resection because of unexpected findings of T4 disease (n = 2) or technical difficulties in addition to advanced disease (n = 8). Between 1991 and 1994, 1 of 26 bypasses was unplanned and the hospital mortality was 42% (11/26), while between 1995 and 1998, 9 of 12 bypasses were unplanned and the hospital mortality was 8% (1/12). There were 12 hospital deaths in the planned bypass group (n = 28) and none in the unplanned bypass (n = 10) group (43% vs 0%, P = .01). The median survival in patients who underwent unplanned bypass was 6.9 months, compared with 1.9 months in patients who underwent planned bypass (P = .004). All patients were discharged from the hospital on at least a semisolid diet. Conclusions: The Kirschner operation is largely obsolete as a planned procedure because of high morbidity and mortality. Bypass surgery, however, is a reasonable option as an unplanned procedure when resection is precluded at the time of exploration because of unexpected adverse operative findings.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.titleThe Kirschner operation in unresectable esophageal cancer: Current applicationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=137&issue=11&spage=1228&epage=1232&date=2002&atitle=The+Kirschner+operation+in+unresectable+esophageal+cancer:+current+applicationen_HK
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.emailChu, KM: chukm@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.identifier.authorityChu, KM=rp00435en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid12413307-
dc.identifier.scopuseid_2-s2.0-0036850017en_HK
dc.identifier.hkuros77498en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036850017&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume137en_HK
dc.identifier.issue11en_HK
dc.identifier.spage1228en_HK
dc.identifier.epage1232en_HK
dc.identifier.isiWOS:000179090900003-
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.scopusauthoridChu, KM=7402453538en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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