Esophagogastrectomy: a consecutive single-center series
de Gara, C.J.; Payne-James, J.J.; Silk, D.B.; Misiewicz, J.J.; Menzies-Gow, N.
Hepato-Gastroenterology 39(6): 515-519
1992
ISSN/ISBN: 0172-6390 PMID: 1483663 Document Number: 389456
We present a 7-year consecutive, non-selected, single-center series of patients (n = 140) submitted to surgery for esophageal or upper gastric malignancy. Follow-up data are complete for 96.4% of patients. Of 114 intrathoracic anastomoses, 74 (65%) were esophagogastric and 40 (35%) were esophagojejunal. Unresectable lesions were present in 26 (19%) patients. Age (mean +- sd 64.6 +- 11.1 years), and sex distribution were similar in all groups, while 36% of patients were over 70 years. There was no significant difference in the time from the onset of symptoms to presentation between the groups (p lt 0.05). The values of admission hemoglobin, serum albumin, PaO-2 or peak expiratory flow rate did not correlate with survival. There was no significant difference in 30-day operative mortality between the three procedures - esophagectomy 5%, thoraco-abdominal gastrectomy 10.8% and unresectable 11.5% (p lt 0.05). The incidence of respiratory complications was the same whether right (30%) or left (35%) thoracotomy was performed. Some 33% of patients were discharged from hospital after 14 days and 72% after 21 days (12.9% died in hospital). One-year survival was 33.4% for esophagectomy, 37.5% for total gastrectomy and 6% for unresectable lesions. The esophagectomy versus total gastrectomy survival curves were not significantly different, but there was a significantly survival advantage when patients undergoing esophagectomy were compared with those who had unresectable tumors (0.02 gt p gt 0.01). No esophagectomy patient has survived beyond 4 years, while total gastrectomy 5-year survival was 18%. To date, all Stage I patients are alive, the Stage II survival of 284 +- 311 days was not significantly (p = 0.6) different from that of Stage III disease (361 +- 401 days). Stage III disease survival was, however, significantly (p lt 0.001) longer than that of Stage IV disease (89 +- 95 days). There was no significant difference (p = 0.1) between resectable and non-resectable Stage IV (120 +- 103 days) survival. Despite the poor long-term outcome, resection remains the best palliation for obstructing lesions of the esophagus and the cardia. This series confirms that acceptable levels of morbidity and operative mortality can be achieved in non-specialist units, but the lack of selection and referral bias will lead to poorer long-term outcomes.