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01-09-2011 | Thoracic Oncology

Two-Stage Operation for High-Risk Patients with Thoracic Esophageal Cancer: An Old Operation Revisited

Authors: Masaru Morita, MD, PhD, FACS, Tomonori Nakanoko, MD, Nobuhide Kubo, MD, Yoshihiko Fujinaka, MD, Keisuke Ikeda, MD, Akinori Egashira, MD, PhD, Hiroshi Saeki, MD, PhD, Hideaki Uchiyama, MD, PhD, FACS, Takefumi Ohga, MD, PhD, Yoshihiro Kakeji, MD, PhD, FACS, Ken Shirabe, MD, PhD, FACS, Tetsuo Ikeda, MD, PhD, Shunichi Tsujitani, MD, PhD, FACS, Yoshihiko Maehara, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 9/2011

Abstract

Purpose

An esophagectomy followed by reconstruction for esophageal cancer is a highly aggressive operation. The purpose of this study was to justify a two-stage operation for high-risk patients with esophageal cancer.

Methods

The clinical results of 27 patients who underwent two-stage operation were compared with 118 patients who underwent a simultaneous resection and reconstruction (control subjects). The reasons for the selection of the two-stage operation were underlying general disease in 13 patients (liver dysfunction, n = 6; pulmonary disease, n = 3; poor performance status, n = 2; diabetes and renal failure, n = 1 each) and high-risk operation in 14 other patients (colon interposition, n = 7; salvage operation after definitive chemoradiotherapy, n = 4; and intraoperative events, n = 3). The patients initially underwent an esophagectomy and a cervical esophagostomy. Reconstruction was usually performed 2–3 weeks later.

Results

The patients in the two-stage group were older than the control patients (mean 67.8 vs. 61.6 years old). The morbidity rate of the two-stage operation was 29.6%, which was not statistically different than control patients (32.2%). Postoperative complications in the two-stage operation were anastomotic leakage in 5 patients, and pneumonia and wound infection in 1 patient each. No patient experienced in-hospital death. The survival rates were not statistically different between the two groups.

Conclusion

A two-stage operation is a safe operation that prevents the occurrence of critical postoperative complications, and it thus may be considered an important treatment strategy for high-risk patients with esophageal cancer.

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Title: Two-Stage Operation for High-Risk Patients with Thoracic Esophageal Cancer: An Old Operation Revisited
Authors: Masaru Morita, MD, PhD, FACS
Tomonori Nakanoko, MD
Nobuhide Kubo, MD
Yoshihiko Fujinaka, MD
Keisuke Ikeda, MD
Akinori Egashira, MD, PhD
Hiroshi Saeki, MD, PhD
Hideaki Uchiyama, MD, PhD, FACS
Takefumi Ohga, MD, PhD
Yoshihiro Kakeji, MD, PhD, FACS
Ken Shirabe, MD, PhD, FACS
Tetsuo Ikeda, MD, PhD
Shunichi Tsujitani, MD, PhD, FACS
Yoshihiko Maehara, MD, PhD, FACS
Publication date: 01-09-2011
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 9/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-1654-y

At a glance: The STEP trials

Springer Medicine

Two-Stage Operation for High-Risk Patients with Thoracic Esophageal Cancer: An Old Operation Revisited

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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