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Skeletonizing en bloc esophagectomy for cancer
J M Collard1, J B Otte, R Fiasse
1Department of Surgery, Louvain Medical School, Brussels, Belgium. collard@chir.ucl.ac.be
Annals of Surgery
|June 23, 2001
Summary
Skeletonizing en bloc esophagectomy offers long-term survival for a third of esophageal cancer patients with resectable extraesophageal tissues. This advanced surgical approach improves outcomes for select patients with advanced disease.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Esophageal Cancer Research
Background:
- Conflicting opinions exist regarding the benefits of extended resection of locoregional lymph nodes and soft tissues during esophageal tube removal.
- The optimal surgical strategy for esophageal cancer, particularly concerning the extent of resection, remains a subject of debate.
Purpose of the Study:
- To evaluate the long-term outcomes of esophageal cancer patients undergoing en bloc resection of the extraesophageal component with the esophageal tube.
- To assess the feasibility and survival rates associated with skeletonizing en bloc esophagectomy.
Main Methods:
- A total of 324 patients with esophageal cancer underwent attempted skeletonizing en bloc esophagectomy, involving resection of the esophagus, locoregional lymph nodes, and adjacent soft tissues.
- Various surgical approaches were utilized, including right thoracic, transdiaphragmatic, and left thoracic routes, with lymphadenectomy performed in the abdomen, mediastinum, and sometimes the neck.
- Resection completeness, tumor depth, and lymph node involvement were key classification criteria.
Main Results:
- Skeletonizing en bloc esophagectomy was successfully performed in 73% of patients (235/324).
- The overall 5-year survival rate was 35%. Patients with intramural tumors had a significantly higher 5-year survival rate (64%) compared to those with extraesophageal disease (19%).
- Survival rates were also influenced by lymph node metastasis: 43% for fewer than five positive nodes versus 11% for five or more.
Conclusions:
- Attempting skeletonizing en bloc esophagectomy provides long-term survival for approximately one-third of esophageal cancer patients with resectable extraesophageal neoplastic tissues.
- This surgical strategy is beneficial for a subset of patients (12% of the total series) with advanced disease, offering a chance for improved survival outcomes.