Oesophagectomy: the lessons learnt from 128 cases

The mortality and morbidity of oesophagectomy are examined in this retrospective review of 128 patients with benign and malignant oesophageal disease. There were 11 deaths in hospital. The operative mortality was not influenced by age, sex, or the approach to oesophagectomy, but was significantly greater in patients given chemoradiation therapy before surgery. Complications were frequent in the early postoperative period and some were due to avoidable errors in technique or selection of operative approach. Follow-up was complete in over 90% of survivors. Late complications included aspiration pneumonia secondary to gastric stasis following total oesophagectomy and anastomotic recurrence after the one-stage procedure of gastro-oesophagectomy. When the whole stomach is used to replace the oesophagus a pyloroplasty is advised. The one-stage operation is not recommended for squamous cancer of the distal oesophagus and adenocarcinoma of the cardia.