Departmental Bulletin Paper Short-term outcomes after conventional transthoracic esophagectomy

Niwa, Yukiko  ,  Koike, Masahiko  ,  Hattori, Masashi  ,  Iwata, Naoki  ,  Takami, Hideki  ,  Hayashi, Masamichi  ,  Kanda, Mitsuro  ,  Kobayashi, Daisuke  ,  Tanaka, Chie  ,  Yamada, Suguru  ,  Fujii, Tsutomu  ,  Nakayama, Goro  ,  Sugimoto, Hiroyuki  ,  Nomoto, Shuji  ,  Fujiwara, Michitaka  ,  Kodera, Yasuhiro

78 ( 1 )  , pp.69 - 78 , 2016-02 , Nagoya University Graduate School of Medicine, School of Medicine
ISSN:0027-7622
Description
In our department, we have attempted to reduce the incidence of complications of conventional esophagectomy. The objective of this retrospective study was to report the short-term outcomes of esophagectomy. We reviewed 138 consecutive patients who had undergone subtotal esophagectomy by combined laparotomy via a 12-cm upper abdominal vertical incision combined with right anterior muscle-sparing thoracotomy from August 2010 to August 2014. Most of the cervical para-esophageal lymph node dissection was completed within the thoracic cavity. We performed three-field dissection in patients with tumors in the upper or middle third of the esophagus with clinical lymph node metastases in the superior mediastinum; the others underwent two-field dissection. We performed neck anastomoses in patients undergoing three-field dissection and thoracic anastomoses in those undergoing two-field dissection. Effective postoperative pain management was achieved with a combination of epidural anesthesia and paravertebral block. Postoperative rehabilitation was instituted for early ambulation and recovery. Enteral nutrition via a duodenal feeding tube was administered from postoperative day 2. Median hospital stay after surgery was 15 days (range, 10–129). Rates for both 30-day and in-hospital mortality were 0%. Morbidity rate for all Clavien–Dindo grades was 41.3%, whereas the morbidity rate for Clavien–Dindo grades III and IV was 7.2%. Anastomotic leakage developed in two patients (1.4%), recurrent laryngeal nerve palsy in 11 (8.0%), and pneumonia in nine (6.5%). Good short-term outcomes, especially regarding anastomotic leaks, were achieved by consistent improvements in surgical techniques, optimization of several operative procedures, and appropriate perioperative management.
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