Intrathoracic anastomosis after oesophageal resection for cancer

✍ Scribed by Agrawal, Shefali; Deshmukh, Sanjay P.; Patil, Prakash K.; Bhansali, Mehul S.; Bhatt, Rajiv G.; Badwe, Rajendra A.; Deshpande, Ramakant K.; Desai, Prafulla B.

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 465 KB
• Volume: 63
• Category: Article
• ISSN: 0022-4790
• DOI: 10.1002/(sici)1096-9098(199609)63:1<52::aid-jso9>3.0.co;2-p

✦ Synopsis

Cervical anastomosis has been advocated to avoid the pulmonary complications and life-threatening anastomotic disruptions following intrathoracic oesophagogastric anastomosis. This is a retrospective review of 11 1 oesophageal resections followed by an intrathoracic anastornosis. These resections were performed between September 1993 and August 1994 within a residency training program. The left thoracoabdominal approach was used for distal tumours and the Tvor Lewis technique for more proximal tumours. Squamous cell carcinoma accounted for 72% patients (n = 80), adenocarcinoma for 25% (n = 28), and others for 2.7% patients (n = 3). Of the patients, 69% had pathologic Stage 111 tumours. Operative mortality rate was 1.8% (two patients). Perioperative complications occurred in 39 patients, including anastomotic leak in 10 patients and myocardial infarction in 2 patients. In the absence of a leak, there were no major pulmonary complications requiring intensive care or ventilatory support. Of those patients with anastomotic disruption, 80% were salvaged by early clinical diagnosis and appropriate treatment. We conclude that transthoracic oesophagectomy with an intrathoracic anastomosis is a safe procedure that can be performed with low mortality and acceptable morbidity.