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Esophagectomy and staged reconstruction.

F V DiPierro1, T W Rice, M M DeCamp

  • 1Department of Thoracic and Cardiovascular Surgery, The Center for Swallowing and Esophageal Disorders, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195-5066, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 17, 2000
PubMed
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Staged esophageal reconstruction offers a complex management option. Outcomes are poor, particularly for cancer patients, emphasizing early reconstruction for benign conditions.

Area of Science:

  • Gastrointestinal surgery
  • Surgical reconstruction techniques
  • Upper gastrointestinal tract procedures

Background:

  • Staged esophageal reconstruction following diversion is a management strategy for complex upper gastrointestinal issues.
  • This approach involves esophageal resection, diversion, and subsequent reconstruction.
  • It is considered in cases of both malignant and benign esophageal diseases.

Purpose of the Study:

  • To characterize the circumstances and indications for staged esophageal reconstruction.
  • To evaluate the outcomes and identify predictors of success in these complex cases.
  • To estimate the optimal timing for reconstruction to improve patient survival.

Main Methods:

  • A retrospective review of 43 patients who underwent planned staged esophageal reconstruction between 1981 and 1999.

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  • Patients were categorized by disease (esophageal cancer vs. benign complications) and diversion type (primary vs. secondary).
  • Multivariable analyses were employed to assess survival, competing risks of death, and optimal reconstruction timing.

    • Main Results:

    • Overall survival rates were 75% at 3 months, 21% at 5 years, and 9% at 10 years.
    • Survival was marginally better for benign disease compared to malignant disease (P=0.06).
    • A significant proportion of patients died before reconstruction; reconstruction typically occurred 9 months post-diversion, with poor outcomes in cancer patients.

    Conclusions:

    • Staged esophageal reconstruction patients are a heterogeneous group with varied pathologies and diversion histories.
    • Outcomes are generally poor and significantly influenced by the underlying disease and timing of diversion.
    • Early reconstruction is recommended for benign conditions, while its indication in cancer patients is limited.