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Article: Influence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer

TitleInfluence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for cancer
Authors
KeywordsComplications
Esophageal neoplasm
Esophagectomy
Morbidity
Mortality
Orthotopic route
Retrosternal route
Route of reconstruction
Issue Date2003
PublisherS Karger AG. The Journal's web site is located at http://www.karger.com/DSU
Citation
Digestive Surgery, 2003, v. 20 n. 3, p. 209-214 How to Cite?
AbstractBackground: A choice of retrosternal or orthotopic route for reconstruction exists after three-phase esophagectomy with cervical anastomosis. Whether the route of reconstruction affects postoperative morbidity, mortality and recurrence patterns remains controversial. Study Design: Patients with cancer of the thoracic esophagus who underwent three-phase esophagectomy between 1990 and 1999 were studied. Postoperative outcome, recurrence patterns and survival were analyzed from a prospectively collected database. Results: Seventy-five patients underwent three-phase esophagectomy. There were 46 patients in the retrosternal group and 29 in the orthotopic group. The mean age of the retrosternal group was younger than the orthotopic group, 60 and 66 years, respectively (p = 0.004). The retrosternal group also had more advanced disease; 24% of patients had curative resection compared with 59% in the orthotopic group (p = 0.003). There was no significant difference in postoperative complications except that the retrosternal group had more blood loss, median 800 ml compared with 700 ml (p = 0.04). Hospital mortality was 13% in the retrosternal group and 3.4% in the orthotopic group (p = 0.24). Multivariate analysis showed that age (odds ratio 1.16, p = 0.035) and pulmonary risk (odds ratio 10, p = 0.01) were predictive of hospital mortality, but not the route of reconstruction. No patient in the retrosternal group developed recurrence in the gastric conduit compared to 4 of 28 patients (14%) in the orthotopic group (p = 0.03). Two of these patients were symptomatic with bleeding from the intragastric recurrence. Survival was worse in the retrosternal group, 5-year survival was 29.8 vs. 8.2% (p < 0.01), reflecting the more advanced disease and higher prevalence of palliative resections. Conclusions: Cardiopulmonary complications and hospital mortality were not significantly different in the two groups. Recurrent tumor infiltration of the gastric conduit occurred in 14% of patients when the orthotopic route was used. Copyright © 2003 S. Karger AG, Basel.
Persistent Identifierhttp://hdl.handle.net/10722/83985
ISSN
2015 Impact Factor: 1.728
2015 SCImago Journal Rankings: 1.001
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorWong, ACCen_HK
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:47:33Z-
dc.date.available2010-09-06T08:47:33Z-
dc.date.issued2003en_HK
dc.identifier.citationDigestive Surgery, 2003, v. 20 n. 3, p. 209-214en_HK
dc.identifier.issn0253-4886en_HK
dc.identifier.urihttp://hdl.handle.net/10722/83985-
dc.description.abstractBackground: A choice of retrosternal or orthotopic route for reconstruction exists after three-phase esophagectomy with cervical anastomosis. Whether the route of reconstruction affects postoperative morbidity, mortality and recurrence patterns remains controversial. Study Design: Patients with cancer of the thoracic esophagus who underwent three-phase esophagectomy between 1990 and 1999 were studied. Postoperative outcome, recurrence patterns and survival were analyzed from a prospectively collected database. Results: Seventy-five patients underwent three-phase esophagectomy. There were 46 patients in the retrosternal group and 29 in the orthotopic group. The mean age of the retrosternal group was younger than the orthotopic group, 60 and 66 years, respectively (p = 0.004). The retrosternal group also had more advanced disease; 24% of patients had curative resection compared with 59% in the orthotopic group (p = 0.003). There was no significant difference in postoperative complications except that the retrosternal group had more blood loss, median 800 ml compared with 700 ml (p = 0.04). Hospital mortality was 13% in the retrosternal group and 3.4% in the orthotopic group (p = 0.24). Multivariate analysis showed that age (odds ratio 1.16, p = 0.035) and pulmonary risk (odds ratio 10, p = 0.01) were predictive of hospital mortality, but not the route of reconstruction. No patient in the retrosternal group developed recurrence in the gastric conduit compared to 4 of 28 patients (14%) in the orthotopic group (p = 0.03). Two of these patients were symptomatic with bleeding from the intragastric recurrence. Survival was worse in the retrosternal group, 5-year survival was 29.8 vs. 8.2% (p < 0.01), reflecting the more advanced disease and higher prevalence of palliative resections. Conclusions: Cardiopulmonary complications and hospital mortality were not significantly different in the two groups. Recurrent tumor infiltration of the gastric conduit occurred in 14% of patients when the orthotopic route was used. Copyright © 2003 S. Karger AG, Basel.en_HK
dc.languageengen_HK
dc.publisherS Karger AG. The Journal's web site is located at http://www.karger.com/DSUen_HK
dc.relation.ispartofDigestive Surgeryen_HK
dc.rightsDigestive Surgery. Copyright © S Karger AG.en_HK
dc.subjectComplicationsen_HK
dc.subjectEsophageal neoplasmen_HK
dc.subjectEsophagectomyen_HK
dc.subjectMorbidityen_HK
dc.subjectMortalityen_HK
dc.subjectOrthotopic routeen_HK
dc.subjectRetrosternal routeen_HK
dc.subjectRoute of reconstructionen_HK
dc.titleInfluence of the route of reconstruction on morbidity, mortality and local recurrence after esophagectomy for canceren_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0253-4886&volume=20&issue=3&spage=209&epage=214&date=2003&atitle=Influence+of+the+route+of+reconstruction+on+morbidity,+mortality+and+local+recurrence+after+esophagectomy+for+canceren_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.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1159/000070387en_HK
dc.identifier.pmid12759500-
dc.identifier.scopuseid_2-s2.0-0038017236en_HK
dc.identifier.hkuros79040en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0038017236&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume20en_HK
dc.identifier.issue3en_HK
dc.identifier.spage209en_HK
dc.identifier.epage214en_HK
dc.identifier.isiWOS:000183020900008-
dc.publisher.placeSwitzerlanden_HK
dc.identifier.scopusauthoridWong, ACC=55118838400en_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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