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Esophagectomy for complex benign esophageal disease.
P F Waters1, F G Pearson, T R Todd
1University of Toronto, Division of Thoracic Surgery, Ontario, Canada.
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 1988
Summary
For patients with severe esophageal issues after multiple failed operations, total thoracic esophagectomy with stomach replacement offers a recommended solution. This procedure provides good to excellent functional results for many, serving as a viable option when other treatments fail.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Thoracic Surgery
Background:
- Multiple unsuccessful esophageal operations often lead to severe, incapacitating symptoms.
- Patients may have primary motor disorders like achalasia or esophageal spasm, frequently complicated by gastroesophageal reflux disease (GERD).
- Previous reconstructive attempts, including colon interposition, may fail, necessitating alternative surgical strategies.
Purpose of the Study:
- To evaluate the efficacy of total thoracic esophagectomy with gastric replacement in patients with failed prior esophageal surgeries.
- To assess the functional outcomes and complications associated with this salvage procedure.
- To determine if total thoracic esophagectomy with stomach is a suitable option for complex esophageal conditions refractory to other treatments.
Main Methods:
- A cohort of 21 patients with a history of 1-4 failed esophageal operations underwent total thoracic esophagectomy and cervical esophagogastric reconstruction.
- Surgical approaches included transhiatal (16 patients) and transthoracic (5 patients) resection.
- Follow-up ranged from 1 to 10 years, with functional results categorized as good to excellent, fair, or poor.
Main Results:
- One perioperative death (5%) occurred due to aspiration following transhiatal esophagectomy.
- Complications included transient anastomotic leak (3), tracheoesophageal fistula (1), recurrent nerve palsy (1), and transient hoarseness (2).
- Functional outcomes were good to excellent in 12 patients, fair in seven, and poor in one.
Conclusions:
- Total thoracic esophagectomy with stomach replacement is a viable salvage procedure for patients with severe esophageal disorders unresponsive to multiple prior operations.
- Given the high failure rate of further hiatal reconstruction attempts in this population, esophagectomy with gastric substitution is recommended.
- This approach can provide significant functional improvement for patients with complex and refractory esophageal conditions.