Esophagectomy without thoracotomy . Procedure of choice for virtually all patients requiring esophageal resection.
[ hide ]
- 1 History
- 2 Use
- 3 Key points
- 4 Morbidity and mortality of esophageal resections
- 5 Surgical results
- 6 Importance and meaning of intra-operative staging
- 7 Conclusion
- 8 Source
Introduced and popularized as a lower surgical risk operation than transthoracic esophageal resections. Supposedly by not requiring a thoracic incision, the surgical trauma is less, at the same time that the cervical anasphageal avoids the very serious complications that can occur in the case of dehiscence of an intrathoracic anastomosis.
Although the blunt esophagectomy technique was introduced in 1930 , it was used very rarely until 1971 when Akiyama published his results in the treatment of cancer of the cervical esophagus creating a definite interest in esophagectomy without thoracotomy in the western world.
Akiyama advised the use of this technique for the treatment of patients with cancer of the cervical esophagus, in whom after completion of the neck resection, the thoracic esophagus is removed without the need for a thoracotomy.
Esophagectomy without thoracotomy was popularized in the United States particularly by Mark Orringer who has been one of the champions of this operation, in his original work Oringer recommended its use in cases of advanced esophageal tumors instead of the retrosternal bypass with stomach.
This technique is used only in special situations. For example: In the resection of the thoracic esophagus in patients operated on for cancer of the pharynx or cervical esophagus. A significant number of patients with esophageal cancer , including patients with regional lymph node invasion , can be cured by radical resection.
Key points that should be analyzed when trying to assess the advantages and disadvantages of esophagectomy without thoracotomy in relation to transthoracic resections.
- Morbidity and mortality of esophageal resections.
- Influence of the extent of resection on surgical results.
- Importance and meaning of intra-operative staging.
Morbidity and mortality of esophageal resections
The continuous progress achieved in the preoperative evaluation and selection of patients in anesthesia techniques and in the area of postoperative care has brought with it a continuous decrease in post-percentages of complications and operative deaths in all types of esophageal surgery, with or without thoracotomy. The advantages of esophageal anastomoses at the cervical level were recognized by many of the proponents of the thoracic tract even before the recent popularity of esophagectomy without thoracotomy. The morbidity and operative mortality of the technique without thoracotomy is comparable to that of transthoracic esophagectomy and there is no difference in surgical risk that demonstrates the superiority of one technique over the other.
Esophagectomy without thoracotomy operation
The postoperative evolution of 51 patients compared with a careful analysis of the operative pieces, revealed that the two most important factors that determined the prognosis of the patients were: neoplastic penetration through the esophageal wall and the presence of metastases in the lymph nodes. regional, whereas neither the histological type, the length, nor the location of the tumor were shown to have a significant influence on the evolution of the patients.
Importance and significance of intra-operative staging
Another of the greatest benefits of transthoracic resections is that they allow adequate intraoperative staging. The precise evaluation of the tumor extension allows the choice of the most appropriate surgical technique and helps to forecast the patient’s distant evolution.
Fundamentally, the exact knowledge of the stage of the disease allows to formulate rational bases to indicate other complementary therapeutic modalities and then to be able to establish scientific comparisons of the results obtained in different centers with different protocols.
Extensive, potentially curative resection is recommended in all patients in whom the tumor has not macroscopically penetrated the entire esophageal wall and / or has not metastasized to regional lymph nodes.